Dear readers,

Recently I went on the Wise Athletes Podcast to discuss how to exercise without getting AFib. We covered all topics related to exercise, AFib, and why athletes seem to be particularly at risk for AFib. If you love to exercise as much as I do this is definitely a podcast you won't want to miss!

Thanks for listening!

John

Wise Athletes Podcast episode website

The 12 Best Ways to Fix Atrial Fibrillation with Sleep
Whenever people try to get healthier, and no matter what the underlying reason for that effort, they almost always start with diet and exercise. Those are two very important factors, but without addressing a third factor—sleep—they are almost assuredly doomed to fail in their efforts to eat better and exercise more. In this article, I'm going to give you my 11 best ways to fix atrial fibrillation with sleep.
Most of Us Are Really Bad at Sleep
Let's face it, most of us are really bad at sleeping. And as a global community, it would appear, we’re actually getting worse at it, even as the science that demonstrates its importance to our lives has gotten more and more compelling. The World Health Organization has raised the possibility that sleep problems are an emerging global epidemic. In the United States, 70 percent of adults report insufficient sleep at least once a month, and 11 percent report insufficient sleep every night.

For a while, it did seem like we were getting the message about the importance of sleep to our health. After a century of consistently diminishing sleep, researchers who study the way we slumber noticed something promising. From 2004 to 2012, the number of people who were getting less than six hours of sleep each night finally started to level out.

Maybe, some thought, we were finally getting the message. Or maybe, others argued, we’d simple hit rock bottom. Either way, it seemed, we could finally start working to move the needle in the other direction. But when demographic sociologist Connor Sheehan and his collaborators dove into the subject in the late 2010s, they were dismayed by what they found. Yes, there had been a leveling out starting in 2004, but between 2013 and 2017 there was a significant shift. Far more people were reporting far less sleep. We hadn’t hit rock bottom after all.

What changed? Among the most important factors are the devices we increasingly carry in our pockets, purses, and person. Closely coinciding with the quickly falling rate of adequate sleep was the rapidly rising rate of smartphone ownership, which went from 35 percent in 2011 to 77 percent in 2016.

“Americans now spend more time looking at a screen,” Sheenan and his collaborators wrote, “and, due to the mobile nature of these devices, technology has increasingly entered the bedroom.” This isn’t just happening in the United States. More than 5 billion people around the world now have mobile devices, and more than half of those devices are a smartphone. Leading the way in the adoption of tiny, glowing screens is South Korea, where 95 percent of adults have a smartphone and where, perhaps not coincidentally, adults get nearly 40 minutes less sleep each night, on average, than their global counterparts.

Because smartphones may be a cause of poor sleep, and also because these devices are increasingly equipped to detect the health consequences that result from poor sleep, it should come as no surprise atrial fibrillation diagnoses have skyrocketed in Korea in recent years.
Why is Sleep so Critical for Atrial Fibrillation?
The impact of poor sleep on AFib has been well documented. Even small interruptions of sleep quality and duration can increase the risk of atrial fibrillation by 18 percent, and people who experience insomnia are 30 to 40 percent more likely to develop atrial fibrillation. People who do not reach deep levels of sleep—the sort of sleep that is key to recovery—have an 18 percent increased risk of atrial fibrillation, and it worsens each time they wake up at night.

It’s even worse for people with sleep disorders such as sleep apnea; they have a 200 to 400 percent increased risk of AFib over individuals without a sleep breathing disorder. And the problem is compounded once AFib actually develops; the presence of an abnormal rhythm c...

The 11 Worst Medications Causing Atrial Fibrillation
Could one of your medications actually be causing your AFib? Over the years I've seen a number of patients either significantly decrease their AFib episodes or even put their AFib into remission for a few years just by getting off an AFib causing medication. For those who needed a particular medication, catheter ablation was very helpful in eliminating the AFib so that they could continue to take their necessary medication. Below are my 11 worst medications causing atrial fibrillation.
1. Diuretics
With the exception of spironolactone (Aldactone) and triamterene, diuretics can be problematic for atrial fibrillation patients. The reason is that most diuretics are well-known to cause mineral depletion in the body. Depletion of those key minerals, especially potassium and magnesium, is often enough to trigger atrial fibrillation.
2. NSAIDs
Non-steroid anti-inflammatory drugs, or NSAIDs, can also induce AFib. NSAIDs are relatively common drugs like ibuprofen and naproxen that are often used to fight pain. NSAIDs are particularly troublesome for AFib patients because they also increase the risk of heart and kidney failure. For those who are also on a blood thinner, NSAIDs increase the risk of an emergency room visit for a life-threatening gastrointestinal bleed.
3. Proton Pump Inhibitors
Proton pump inhibitors, which suppress stomach acid, can also atrial fibrillation by blocking magnesium absorption or possibly by changing a person’s gut microbiome. These drugs include omeprazole, lansoprazole and pantoprazole, which are often sold under the brand names Prilosec, Prevacid, and Nexium, respectively.
4. Steroids
Steroids, like prednisone and Solu-medrol, can cause atrial fibrillation, too, by raising blood glucose levels to very high levels and increasing blood pressure through fluid retention and weight gain. Over my career, I've even seen many cases of steroid injections triggering AFib.
5. Any Stimulant
Cardiac stimulant medications, like albuterol inhalers or theophylline for asthma, have long been associated with AFib. Even over-the-counter decongestants such as pseudoephedrine, which is sold as Sudafed, or medications for attention deficit hyperactivity disorder can trigger an AFib attack. The bottom line is that anything that revs up the cardiovascular system has a risk of causing AFib.
6. Digoxin, Diltiazem, Verapamil, and Beta-Blockers
Perhaps a bit counterintuitively, some if the classic drugs used to treat abnormal heart rhythms such as digoxin, calcium-channel blockers such as verapamil and diltiazem, and beta-blockers have all been associated with an increased risk of AFib. While the exact mechanisms whereby these drugs may increase the AFib risk aren't entirely clear, plenty of cases have been documented in the medical literature. We’ve even seen beta-blockers, which are often used to treat AFib, linked to AFib episodes due to associated weight gain, particularly with women.
7. Fish Oil
As many readers know, there is prescription-strength fish oil, like Lovaza, as well as the over-the-counter fish oil. Prescription-strength fish oil is used to treat high triglycerides whereas the over-the-counter version is used to treat a myriad of complaints. Regardless of which form it is, fish oil has now been implicated as a potential cause of AFib.

If fish oil has been particularly helpful for you, try keeping the dose under 1 gram per day to minimize the risk of AFib. Or, alternatively, you can do what I've done and go back to eating wild-caught fish high in omega 3s instead of taking a supplement. Interestingly, since stopping fish oil for myself, I've noticed a lot fewer palpitations.
8. Antiarrhythmics like Amiodarone, Flecainide, and Propafenone
Another surprise to many readers is that the antiarrhythmic drugs,

The 7 Most Important AFib Triggers to Avoid
A new study was just published identifying the most important AFib triggers to avoid. Avoiding AFib triggers is incredibly important for AFib patients and something we covered in our best-selling book, The AFib Cure. In this article, I discuss the 7 most important AFib triggers to avoid based on published medical studies and my 30 years of experience caring for AFib patients.
What are your AFib triggers?
While most of my patients can identify at least one specific AFib trigger, many cannot. For some of my patients, AFib attacks are 100% random events so they don't have any clearly identifiable triggers. If you can identify one or more AFib triggers, then avoiding these triggers can be a very effective way of putting your AFib into remission naturally.
1. Alcohol
At the top of every published study of AFib triggers is alcohol. Sadly, there is no safe dose of alcohol for AFib patients. And that shouldn’t come as a big surprise as any emergency room doctor can share many stories of high school or college students who have presented with AFib after binge drinking.
2. Exercise
Exercise is the most natural way in the world to shift our hearts into a higher gear, so it’s no shock that, if your heart is already prone to beating erratically, a quick burst of exercise could push it over the edge. But avoiding exercise is simply not an option as not exercising at all dramatically increases your risk of AFib and an early death.

For those suffering from exercise-induced AFib, many of my patients have found that simply decreasing the intensity or duration of their exercise can help tremendously. For others, they can still exercise vigorously without AFib provided they have slept well, are well hydrated, and have their electrolytes in check.

When nothing prevents exercise-induced AFib, it is time to consider an ablation. Indeed, I have countless patients, including elite world-class athletes, who have all successfully returned to high levels of exercise free of AFib with an ablation procedure.
3. Dehydration/Electrolyte Depletion
It always amazes me how so many of my patients' AFib attacks come from when they aren't drinking enough water. Indeed, many of my patients fail to realize that their fatigue, dry skin, headaches, muscle cramps, urinary tract infections, constipation, dizziness, brain fog, or their AFib all happen because they aren't drinking enough water. And proper hydration is especially important for AFib patients before exercising.

In addition to adequate hydration, optimization of electrolytes is also necessary to keep the heart beating right in sinus rhythm. For example, potassium and magnesium depletion are well documented AFib triggers in the medical literature. Fortunately, both can easily be replenished with a diet high in vegetables, fruit, nuts, seeds, legumes, etc. Indeed, many of my patients report that magnesium supplementation has been essential to keeping their AFib in remission.

When it comes to optimizing your electrolytes, please don't turn to sports drinks. Sport drinks are nothing more than sugar water or artificial sweetener water with chemical dyes and a trace amount of electrolytes. If your goal is to optimize for sinus rhythm and longevity, get all the electrolytes your body needs from natural food sources like vegetables, fruit, nuts, seeds, legumes, etc.
4. Poor Sleep
A bad night of sleep is another big AFib trigger. Bad sleep could be from sleep deprivation or sleep apnea. Indeed, studies show that a bad night of sleep increases your risk of AFib 3x the next day and sleep apnea quadruples your AFib risk. Make restorative sleep a priority!

While sleeping on your left side is often uncomfortable for AFib patients, a recent study did not show an increased risk. So, while you may feel more palpitations when sleep...

Is Caloric Density the Secret to Eating as Much as You Want without Gaining Weight?
By Kate Clemens with John Day

Is there a way to never feel hungry again and not gain weight? One answer is to mostly eat only those foods with the absolute lowest caloric density. In other words, a low caloric density means you want the most food you can get on your plate with the least amount of calories. And in this article, we'll teach you everything you need to know about the low caloric density eating approach.
Dr. Day's Experience with Low Caloric Density Eating
Focussing primarily on foods with the lowest caloric density has been something Dr. Day has done for the last 10 years to maintain his 30-pound weight loss. For him, pilling up his plate high with food not only fills his belly but also psychologically convinces his brain that he is full.

As vegetables have the lowest caloric density this is what fills up most of his plate. And because oils have the highest caloric density, he avoids them whenever possible. For example, when making a salad he puts berries, beans, nuts, and seeds on his salad, rather than salad dressing, because berries, beans, nuts, and seeds have a much lower caloric density (see chart).

In general, Dr. Day keeps his caloric density below 780 calories per pound unless he is eating nuts, seeds, or some very dark chocolate (>70% cacao and usually stevia-sweetened). Of note, his wild salmon measures in at about 780 calories per pound. On rare occasions, he will just put a small taste of salad dressing on a fork (he never puts the dressing on the salad) if berries, beans, nuts, or seeds are not available to flavor his salad.
Caloric Density Works
Caloric density is a straightforward approach to weight management that works. The idea is to increase the amount of food on your plate while decreasing your total caloric intake. You do this by paying attention to the calories per pound in the food you choose to eat. The best part of it is that you eat for satiety and optimize the amount of nutrients you take in at each meal.
5 Key Findings from Weight Loss and Caloric Density Research
What does research tell us about the caloric density eating approach? Below is a summary of the best studies:

1. People can eat freely foods that are about 300 calories per pound or less and not gain weight.

2. People can consume relatively large portions of foods that are between 400 and 800 calories per pound and still lose or maintain their weight depending on their individual activity levels and metabolism.

3. Foods with a calorie density of 800-1,800 should be limited as these can contribute to weight gain and interfere with efforts to lose weight.

4. Foods over 1,800 calories per pound should be extremely limited as these foods can very easily contribute to weight gain and obesity and can also greatly interfere with efforts to lose weight.

5. In 2007, the American Cancer Institute and the World Cancer Research Fund published a report which recommended the average calorie density of the American diet be lowered to 567 calories per pound. This can easily be achieved if one eats freely of unrefined, unprocessed fruits, veggies, starchy veggies, and intact whole grains and legumes. It is important to note that this means without the addition of salt, sugar and/or fat/oil to them.
Never Diet Again by Following the Caloric Density Eating Approach
Using the caloric density approach is one that is truly simple and based on common sense. Better yet, it is easy to stick with which allows you to manage your weight for the rest of your life without dieting. Because you essentially end up eating more food with fewer calories, you will feel satiated and happy.

In a nutshell, by having a rough idea of how many calories there are in a given weight of food,...

8 Scientifically Proven Ways to Lower Your Blood Pressure Naturally
Studies show that up to 90% of all Americans will have high blood pressure by age 50! But yet isolated groups of people cut off from our modern lifestyles have normal blood pressures in the range of 110/70 mmHg throughout their lives without the need for medications.

If your goal is to optimize for normal sinus rhythm, a heart free of disease, and a long healthy life, you have to maintain a healthy blood pressure throughout your life. In this article, I will share my 8 scientifically proven ways to lower your blood pressure naturally.
My Struggle with High Blood Pressure
Ten years ago my blood pressure typically ran 140/90 mmHg. And as a cardiologist knowing of the cardiac dangers of high blood pressure, I put myself on a blood pressure-lowering medication.

However, as I lived among the centenarians in the remote Longevity Village area of China, my goal was to naturally reverse all of my medical conditions, including high blood pressure. And by adopting a 99% natural plant-based diet, including a 30-pound weight loss, in conjunction with regular daily exercise, time with my family, and optimization of my sleep and stress levels, my unmedicated blood pressures now consistently run 110/90 mmHg!

Below are the 8 scientifically proven ways I lowered my blood pressure. But if you are currently taking high blood pressure medications, please speak with your doctor first before trying anything in this article.

My concern is that on one hand stopping blood pressure medications could be life-threatening. But yet, on the other hand, getting super healthy while taking blood pressure medications could drop your blood pressure to dangerously low levels. If your goal is to get off blood pressure medications, it will take exceedingly close monitoring while at the same time working with your doctor as you wean off medications.
1. Cut the Sodium
First, you’re going to need to eat a low-sodium diet. This can offer a 4-point reduction in your systolic blood pressure, an effect equivalent to about half a typical blood pressure-lowering medication.
2. Eliminate any Added Sugars
Second, you’ll need to eliminate any added sugars. That’s generally worth a 7-point reduction.
3. Commit to a Daily Workout
Next, it’s time to commit to a daily workout for a 6 to 7 point reduction.
4. Drop Some Weight
The fourth thing is really hard to do by itself, but a ton easier if you’ve done the first three things: You’ve got to drop some weight. How much? Broadly speaking, for every 2 pounds you lose you could expect a 1 point reduction. So, dropping 20 pounds could get you a 10 point reduction.
5. Embrace a High Fiber Diet
Next, you’ll want to embrace a high-fiber diet. And to get there you'll need to eat a lot of vegetables, legumes, and high fiber fruit like berries. My personal goal is 100 grams of fiber daily but something much less than that could still be worth another 6 point reduction.
6. Learn to Eat Plant-Based
Sixth, eating a mostly natural plant-based diet that is high in potassium and magnesium with limited saturated fats has been shown to drop your blood pressure by 6 points.
7. Get More Nitric Oxide from Greens and Root Vegetables
Next, you need to get some more nitric oxide from greens and root vegetables. Eat enough of that molecule, the intake of which causes blood vessels to relax and dilate, and you could enjoy a 5 point reduction in your systolic blood pressure.
8. Lower the Stress Levels
Finally, you’ve got to do something about your stress, which you already know is a key driver of high blood pressure. That can help drive a 5 point reduction in your systolic blood pressure.
Disclaimer
The content provided in this article is for informational purposes only.

13 Simple Weight Loss Tips That Actually Work
Authored by Kate Clemens with Dr. John Day

As Dr. Day revealed in his book, The Longevity Plan, he has struggled to maintain a healthy weight since high school. Indeed, 84% of all Americans report that they have tried to lose weight. Below are our 13 simple weight loss tips that actually work for us and our patients.
1. Diets Don't Work, Lifestyles Do
You go on a diet and then you go off the diet--Diets were never meant to be long-term solutions.

The goal is to find a way of eating that you can maintain for the rest of your life. So the next time you commit to "eating healthy," ask yourself can I eat like this for the rest of my life? If the answer is "no," then you're doomed to fail. You need a lifestyle or way of eating that you can easily maintain until you turn 100.
2. Faithfully Follow Dr. Day's 3 Rules to Eating
As there is so much confusion as to what is healthy eating, Dr. Day's approach is to give his patients 3 simple rules to follow. And if you can just follow these 3 easy rules to eating, then you are 90% of the way there to healthy eating.

First, minimize or avoid any added sugars. We do not need these! Real whole fruits are naturally occurring sugars, these do not count.

Second, minimize or avoid processed foods. If it comes from a box, can, package, fast food window, etc. it is processed. You do not need these "foods." The more natural you eat the better.

Third, eat as many non-starchy vegetables as you can. The more variety in the color of your vegetables the better.
3. Find What Works for You
There is no one perfect diet for everyone. Just because "keto" worked for your friend doesn't mean it will work for you.

For example, everyone says exercising first thing in the morning is best as it will help you to eat healthy all day long. Dr. Day found that exercising in the morning just made him hungry all day long. So for Dr. Day, he can control his eating by exercising late in the afternoon or after dinner.

You are so wonderfully individual. While there are certainly a lot of health "guidelines" out there, these guidelines may or may not help you. Have fun, experiment, and be true to yourself. Remember the ONLY person you should ever compare yourself to is the person you were yesterday.
4. Crash Diets Crash Your Metabolism
Have you ever wondered what happens to the “biggest losers” on reality TV shows? When the cameras stop rolling, do their incredible transformations stick? Not usually. Researchers have found, in fact, that these contestants’ crash diets send their metabolism into a tailspin, making long-term weight maintenance nearly impossible.

In most cases, the weight comes right back and, even six years later, their metabolism is slower than it was before they
started filming. This is what scientists call “metabolic adaptation” and is something you definitely want to avoid.

No matter where you are in all facets of your life, getting to where you want to be is not supposed to happen overnight. After all, you probably put the weight on at a pace of 1 to 2 pounds a year. Do not be afraid of achieving your goals slowly and mindfully, just be sure you are moving forward! We are aiming for progress, not perfection.
5. Have a Daily Plan
We do not plan to fail, we fail to plan. This is a well-known quote for a good reason.

Set yourself up for success! Figure out 5-minute ‘planning window’ either each Sunday or the night before to sketch out what your food week or food day will look like.

For example, as Dr. Day is surrounded by unlimited free treats at every nurse station or the doctor's dining lounge in the hospital, he has to plan out a daily "healthy treat." Without a prepared "healthy treat" in his laptop bag,

Can You Exercise with AFib?
Can you exercise with AFib? And if so, how high can your heart rate go before it is unsafe? We all know that exercise is good for you but does that still hold if you're in AFib? If you or a loved one has AFib, read on to learn more.
Does Exercise Cause AFib?
Most of my patients are shocked to learn that people who run marathons, competitively cycle, or do Ironman triathlons are five times more likely to develop AFib! What is particularly perplexing, however, is that studies have not tended to show higher rates of arrhythmias in athletes who participate in other strenuous forms of exercise, such as boxing, wrestling and weight-lifting.

There is something particular about endurance sports that increases the risk of AFib. One exception to this may be football. Among former NFL athletes, the risk of AFib is six times higher, although this may be due to the use of performance-enhancing substances or the weight these athletes put on to compete at a professional level.

Also, it bears noting that while aggressively competing in endurance sports might put you at a greater risk of AFib, participation in these activities certainly does not guarantee you’ll get AFib. It is reassuring to note that non-competitive recreational participation in endurance sports, even if it is a marathon or triathlon, doesn’t seem to put you at risk of AFib.

I have found over the years that almost all of my athletes with AFib have opted for an early ablation. They simply can't or don't want to exercise with the usual cocktail of AFib drugs that are prescribed. And fortunately for athletes, we typically get excellent results as studies show that the AFib ablation success rates are up to 3 times higher with athletes!
Does Exercise Prevent AFib?
Regular exercise in general isn’t risky at all. In fact, for 99.9% of my patients it’s exceptionally protective. To put things into perspective, for every thousand patients I see with atrial fibrillation, perhaps one may be at risk due to overexercising. The biggest problem, by far, is that most patients aren’t exercising enough.

There is far greater risk to not exercising enough than to exercising too much. People who live sedentary lifestyles are at significant risk of AFib, not to mention all of the other health consequences of not getting enough exercise. Indeed, one study showed that not exercising at all increased your risk of AFib by more than four times!

A big problem for many of my AFib patients is that they want to exercise but either the AFib or their medications make them so tired that they simply can't exercise. And for those people who can't exercise with AFib, we typically end up treating them with an ablation as the health benefits of exercising are too great to ignore.
How High Can Your Heart Rate Go when Exercising in AFib?
As exercise drives the heart rate up, how high can you let the heart rate go when exercising in AFib? For the vast majority of my patients, they are perfectly okay driving their heart rates up to their maximally predicted heart rate. And your maximally predicted heart rate is 220 minus your age.

So if you are 40 years old, I would expect you to hit a heart rate of 180 with high levels of exercise. Of course, if you get chest discomfort or shortness of breath with exercise then you need to notify your cardiologist immediately as your life could be at risk.
How Hard Can You Push Your Heart with Exercise and AFib?
If you love endurance sports, it is perfectly fine to participate as long as your cardiologist is in agreement and your heart feels great during exercise. And if you want to be safe running that marathon, try slowing your running pace. Indeed, among my "plodder" patients, or those who exercise at slow non-competitive speeds, I rarely see AFib.
Dr.

The 4 Best Reasons Why Intermittent Fasting May Prevent AFib
Fasting has been shown to slow aging and help most chronic medical conditions but can intermittent fasting also prevent atrial fibrillation? In this article, I'll share everything you need to know about intermittent fasting's role in atrial fibrillation prevention.
Why Did I Write this Article?
My long-term readers know I've always been impressed by the strong data supporting intermittent fasting for longevity and cardiovascular health. Indeed, both of our books, The Longevity Plan and The AFib Cure, had a section on intermittent fasting. The reason why I chose to cover this topic again came from a recent podcast interview I heard with Dr. David Sinclair.

For those not familiar with Dr. David Sinclair, he is a Harvard University longevity researcher. And interestingly, the person who helped him write his New York Times best-seller, Lifespan, was the same person who helped me write The Longevity Plan and The AFib Cure.

In this podcast, Dr. David Sinclair reported that he doesn't snack and only eats one meal a day. As someone who has always struggled with fasting, my goal is that writing again on the topic of intermittent fasting will help me to redouble my efforts to fast regularly. And to help you redouble your efforts, below are my 4 best reasons why intermittent fasting may prevent AFib.
1. Fasting May Slow Aging
Researchers have long known that caloric restriction, or eating the absolute minimum number of calories to keep the body functioning, makes animals of all types live longer. Indeed, if you're a rat you'll live 80% longer with caloric restriction. But while caloric restriction works great for animals in a controlled experiment, it is almost impossible for humans to maintain caloric restriction long-term.

The beautiful thing is that humans may not need to calorically restrict themselves to achieve this longevity boost. Indeed, intermittent fasting activates the same genes that caloric restriction does.

How does this happen? Studies show that periodic fasting activates an energy-sensing protein called AMP-activated protein kinase (AMPK), which then keeps the energy center of the cell, the mitochondria, in a “youthful” state.

With regards to AFib, as age-related fibrosis (or scarring) of the left atrium is a significant driver of AFib, anything that slows the aging process would be expected to also slow the development of AFib. Indeed, based on a study we were involved with at Intermountain Medical Center, shorter telomeres, which is a marker of premature aging, was associated with atrial fibrillation.
2. Fasting May Lower Blood Pressure 10 mmHg
When we fast, blood sugar levels are less likely to spike high. The research is pretty clear, the more time we can give our bodies a break from food the better our insulin sensitivity, the slower our body "rusts" with aging, and the lower our blood pressure runs.

And when it comes to AFib, lower is usually better. Indeed, studies show that high blood pressure doubles the risk of AFib. So if you suffer from AFib, the goal is to keep your blood pressure always below 130/80 mmHg. But if your goal is to maximize longevity, then the research suggests a blood pressure in the range of 110/70 mmHg, without the help of blood pressure medications, is where you probably need to be.
3. Fasting is Good for a 9 Pound Weight Loss
If you're looking for a quick 9-pound weight loss, then the science suggests you may want to try intermittent fasting. For example, I have found that when I skip dinner I eat approximately 500 fewer calories for the day. And these 500 fewer calories are maintained even after accounting for any "make-up" calories I may consume on the following days.

While most people practice intermittent fasting by skipping breakfast,

The 7 Best Ways to Stop an AFib Attack
If you find yourself experiencing a very occasional incident of AFib, you need not panic provided you aren't about to pass out, you're experiencing chest discomfort, or you're short of breath. Of course, if AFib is happening repeatedly then you need to see your cardiac electrophysiologist or "EP" as soon as possible. An EP is a cardiologist who has had two additional years of training in arrhythmias following their cardiology board certification.

And the off chance that such an attack might happen in a very inconvenient time—like when you’re on a long international flight, taking a cruise, or in a very remote area of the world—absolutely shouldn’t stop you from living your life.

Lots of people travel with a first aid kit. That doesn’t mean they intend to use it—it simply means they are ready in case something happens. No matter how long your AFib has been in remission from massive lifestyle changes or an ablation, I suggest having a plan of response ready to go, especially when you know you’re going to be away from a hospital or doctor for a while. As the Boy Scout motto goes: “Be prepared.”
1. "Pill-in-the-Pocket"
First, keep an antiarrhythmic medication, like flecainide, on hand for an emergency. Sometimes, my patients may also have a medication to also slow down their heart and a blood thinner in addition to the flecainide on hand for an emergency.

Even though many of our patients haven’t had an AFib episode in years following an ablation, many still keep an antiarrhythmic in their wallet, purse, or car just in case their heart ever starts fibrillating again. If nothing else, it gives them peace of mind and a sense of control should anything ever change.
2. Rehydrate
Next, always be ready to rehydrate. As dehydration is a big AFib trigger, many of our patients report that they are able to quickly get back to sinus rhythm simply by rehydrating. Always travel with clean water at arm’s reach.
3. Optimize Your Electrolytes
Third, keep your electrolytes up. Low levels of magnesium and potassium are another common AFib trigger. A quick boost through electrolyte-heavy foods, or drinks like tomato juice or low-sodium vegetable juices, is always a good bet. But if you’re going to be away from a place where you can access these foods and drinks, supplements are a good idea, especially in the case of magnesium.
4. Exercise Away Your AFib Attack
Fourth, exercise. While it may seem very counterintuitive, many of my patients report that all they need to do is to overtake their AFib heart rate with an elevated exercise heart rate to get back in normal sinus rhythm. When their heart slows after the exercise, their normal sinus rhythm is restored.

Of course, if your heart rate runs especially fast with an AFib attack then driving the heart rate up even higher with exercise wouldn't be a good idea. For those whose hearts break speed records with AFib, option number 5 below may be a much better choice.
5. Lie Down
Fifth, lie down. If an exercise-induced increased heart rate doesn’t work for you, the opposite might do the trick. Many of my patients report that taking a nap or going to bed early when they are in AFib is the trick to getting back in rhythm.
6. Stimulate Your Vagus Nerve
Sixth, stimulate your vagus nerve. Sometimes autonomic nervous system imbalances can trigger AFib. One way to quickly correct this is through vagal maneuvers, like slow deep breathing, bearing down like you are trying to have a bowel movement, tightening your abdominal muscles, inverting your body by raising your legs or standing on your head, coughing, or taking a cold shower.
7. Get a Quick Cardioversion
Finally, if all else fails, it’s time to visit an ER during off-hours or your cardiologist/EP's office for a quick cardioversion to restore normal sinus rhy...

Is Fish Oil Still Good for the Heart and Longevity?
Is fish oil still good for the heart? Ten or 20 years ago I would have said most definitely for the heart and possibly for longevity. Now, I'm not so sure.
Six Reasons Why I Took Fish Oil in the Past
1. Fish Oil May Lower Blood Pressure 1-2 Points

Studies show that fish oil may have a slight blood pressure-lowering effect in the range of 1-2 mmHg. And as my long-time readers know, the goal blood pressure to prevent heart disease and to optimize for longevity seems to be about 110/70 mmHg. To put this blood pressure-lowering effect of fish oil into perspective, you could get this same 1-2 mmHg blood pressure reduction from losing just 2-4 pounds.

2. Fish Oil Lowers Triglycerides

High levels of triglycerides in the blood can cause all sorts of damage to your vascular system. And fish oil has long been proven to lower triglycerides. However, whatever benefit you may gain in triglyceride-lowering from fish oil, simply eliminating all added sugars and flour may lower your triglycerides even more!

3. Fish Oil May Keep Inflammation Levels Lower

Once again, long-term readers know that keeping inflammation levels low may be the secret to avoiding cardiovascular disease, including atrial fibrillation, and optimizing for longevity. And science suggests that fish oil may help to reduce inflammation levels. As my personal goal is to have a C-reactive protein (CRP) lab value of zero despite having a history of an autoimmune condition, this provided an additional reason for me to take fish oil. For those not familiar with the CRP blood test, a CRP reading of zero indicates no significant inflammation going on anywhere in the body.

4. Fish Oil May Promote Longevity

Although the data is weak, some studies report a longevity benefit from fish oil. For example, in this study, fish oil helps to prevent the telomere shortening that comes with aging. While many studies report that higher blood levels of omega-3's are associated with an increased lifespan, it isn't clear to me if this is from fish oil or from eating real fish.

5. Fish Oil May Help with Weight Loss

Once again, the data here is weak but yes, there are studies reporting that fish oil helps with weight loss. Indeed, some studies report that fish oil may reduce hunger and enhance metabolism. As one who has struggled to keep my weight in check, I was eager for any help I could get. Sadly, I didn't notice any reduction in my hunger or an increased calorie burn with fish oil.

6. Fish Oil May Help with Dry Eyes and Dry Skin

Yes, fish oil has been shown to help with dry eyes and dry skin. And given that I live in the very dry state of Utah, my hope was that fish oil would help me better tolerate contact lenses and help to moisturize my skin. But with many of the other possible fish oil benefits, it didn't really seem to help my dry eyes or my dry skin.
Fish Oil Doesn't Seem to Prevent Heart Disease and Cancer
With all of the above reasons to take fish oil, one would hope that fish oil prevents heart disease and cancer. So in the biggest and most rigorous study to date, the recently completed VITAL Trial randomized nearly 26,000 patients to approximately 1 gram/day of fish oil or placebo for over 5 years. Sadly, faithfully taking fish oil for over 5 years didn't prevent heart disease nor did it prevent cancer.
Fish Oil May Increase Your Risk of Atrial Fibrillation
While fish oil didn't seem to impact heart disease risk, a just-published sub-study of the VITAL Trial showed a non-statistical trend toward an increased risk of atrial fibrillation from taking 1 gram/day of fish oil. To put this finding in perspective, a study using 2 grams/day of fish oil also showed a non-statistically significant increased risk of atrial fibrillatio...

Get Out of AFib as soon as Possible
A recent study reported that your risk of cardiac death, stroke, or hospitalization could be decreased by 22% if you can get out of AFib as soon as possible. If you're feeling okay, is there really a rush to get your heart back in rhythm? In this article we discuss the research behind the title of this article--get out of AFib as soon as possible.
EAST-AF Study
The EAST-AF Study was the recent study reporting 22% fewer cardiac deaths, strokes, or hospitalizations with an early rhythm control strategy for AFib. This study was a well-designed randomized controlled multi-center study published in the most prestigious medical journal in the world.

Indeed, of the 2,791 patients followed for over 5 years, the EAST-AF researchers found that all of the bad things mentioned above (cardiac death, stroke, or hospitalization) could be significantly reduced if patients could get out of Afib within 12 months.  I could only imagine how much more successful the results of this study would have been if they had gotten their patients back in rhythm within a day, like we do in our practice, rather than wait up to a year!
"Get Out of AFib" also Benefits Heart Failure Patients
In a follow-up to the EAST-AF Study discussed above, a new sub-study just looking at heart failure patients with AFib was published. As AFib patients with heart failure are the highest risk AFib patients, it makes sense to see whether early rhythm control also benefits the sickest of the AFib patients.

As you might expect, the 798 patients with heart failure patients with AFib in this sub-study also benefited significantly from a strategy to get out of AFib. Taken together, these two studies provide a very convincing message that people do best when their hearts are beating in normal sinus rhythm.
How Long Do You Have to Get Out of AFib?
The real question from the EAST-AF main study, as well as the sub-study, is how long do you have to get out of AFib? We certainly know that the longer you are in AFib the harder it is to correct. This is because people that have been out of rhythm too long start to have enlargement of the upper chambers of their heart from too much scar tissue.

Indeed, my co-author on the best-selling book, The AFib Cure, Dr. Jared Bunch, and I wrote an article a few years back discussing the "AFib tipping point." The AFib tipping point is when you have been out of rhythm so long that normal sinus rhythm is no longer possible. Based on the best research available, electrical degenerative changes to the heart can start to develop within as little as 5 hours of AFib. Even more worrisome is that new scar tissue can develop within 5 weeks of uninterrupted AFib.

This AFib tipping point varies from patient to patient but in general the older you are the faster the tipping point comes. Obviously, if your goal is normal sinus rhythm then the sooner you can get out of AFib the better.
The Longer You Wait for an Ablation the Lower the Success Rate
The AFib tipping point also plays a factor when looking at ablation success rates. Indeed, in our study of 4,535 atrial fibrillation ablation patients, the sooner they could go from AFib diagnosis to ablation the better their long-term freedom from AFib. And this only makes sense as AFib causes degenerative changes to the heart so the sooner you can get out of AFib the better.

But just getting back in rhythm quickly with an AFib ablation is only half the story. The other key finding of our study was that with an early ablation our patients could also cut their death rate in this study by 2.5x as well as cut their hospitalization risk by 1.7x! Once again, when the heart is out of rhythm bad things are more likely to happen.
Dr. Day's 5 Thoughts on Early Rhythm Control for AFib
1. The sooner you can get back in rhythm the better.

Is Vitamin D Good for the Heart, Longevity, and Atrial Fibrillation?
My answer to is vitamin D good for the heart, longevity, and atrial fibrillation is changing based on the most recent studies. While low vitamin D levels are definitely associated with heart attacks, heart failure, atrial fibrillation, longevity, cancer, infections, premature death, dementia, etc. it is becoming increasingly clear that taking a vitamin D supplement may not decrease the risk of any of these bad things happening. So what do the latest studies say and should we still take a vitamin D supplement for low vitamin D levels? Read on to learn more.
The Vital Trial
The main findings of the Vital Trial were published in 2019. This was a randomized controlled trial (RCT) which is the highest
quality study you can do. It was also published in the most prestigious medical journal, The New England Journal of Medicine.

The Vital Trial enrolled 12,987 patients and through a complex randomization process specifically evaluated whether taking 2,000 IU of vitamin D or a placebo could prevent cancer, heart attacks, strokes, or a cardiac death. To get into the Vital Trial you had to be age 50 or older if male and 55 or older if female. The reason why they picked an older age group is that at these ages the risk of heart disease and cancer start really going up.

As you might suspect, for those randomized to 2,000 IU of vitamin D, their 25-hydroxyvitamin D levels did somewhat increase from 29.8 ng/mL to 41.8 ng/mL. For those not familiar with 25-hydroxyvitamin D levels, normal is 30 to 100 ng/mL. With this in mind, you can see that the people studied didn't really have that low of vitamin D levels, to begin with. Regardless, researchers then following these 12,987 patients for the next 5.3 years to see if this slight increase in vitamin D levels could prevent cancer, heart attacks, strokes, or a cardiac death.

Sadly, 2,000 IU of vitamin D daily did none of the above. There was no statistical difference in the number of cancers, heart attacks, strokes, or cardiac deaths between the vitamin D supplement group and the placebo group. And a just-published sub-study from the Vital Trial also showed that a 2,000 IU vitamin D supplement did nothing to prevent atrial fibrillation. Surprisingly, even in the group with super low vitamin D levels (less than 20 ng/mL) a daily vitamin D supplement still didn't prevent atrial fibrillation.
Vital Trial and Atrial Fibrillation Risk
So what did all these millions of dollars spent on this study really teach us? Well, we learned that even though low vitamin D levels have been shown to be associated with an increased risk of atrial fibrillation, a supplement doesn't seem to fix anything.

Of course, one could argue that only increasing 25-hydroxyvitamin D levels from 29.8 to 41.8 ng/mL is simply not enough to make a difference in arrhythmias. And it's certainly possible that many episodes of atrial fibrillation during the 5 plus years of follow-up were probably missed as these people were not continuously monitored for arrhythmias. And given that the mean age of this study was 67, one could also argue that the results may not apply to younger patients.
Our 2011 Vitamin D Atrial Fibrillation Study
When trying to assess the results of the atrial fibrillation Vital Trial, I have to put in a plug for our 2011 vitamin D atrial fibrillation study. In this study, we looked at the impact of vitamin D on 132,000 patients within the Intermountain Healthcare system in Utah and Idaho.

In our study, the average age was 52 and 71% of the patients were women (as opposed to the 50/50 male-female mix in the Vital Trial). One finding of our study was that there was a trend toward low vitamin D levels being associated with atrial fibrillation (14% increased risk that didn't quite reach statistical significance). However,

Ablation or Drugs First for Atrial Fibrillation?
Should you do ablation or drugs first for atrial fibrillation? Technically, I would argue neither as studies show that with aggressive lifestyle changes, including weight loss, up to 50% of atrial fibrillation cases can be put into remission without drugs or procedures! Assuming you have already tried lifestyle changes, let's discuss next options--ablation or drugs first for atrial fibrillation based on three recently published meta-analysis studies.
Background Information
If you're not sure what an ablation is, or what drugs are used for atrial fibrillation, then this section is for you. For advanced readers, feel free to skip down to the next section.

Catheter ablation is an outpatient procedure whereby a cardiologist specializing in arrhythmia treatment (cardiac electrophysiologist or "EP") inserts catheters into the heart through a vein in the leg. And then while the patient is asleep, the "EP" will cauterize or freeze those areas of the heart that are misfiring. And the goal of catheter ablation is no more AFib and no more anti-arrhythmic medications.

Anti-arrhythmic drugs have traditionally been used first to keep hearts beating in rhythm. Under the old treatment paradigm, ablations were only recommended when drugs failed. Mechanistically, anti-arrhythmic medications change the electrical connections between cells in the heart. If everything goes as hoped then the drug keeps your heart in rhythm and you don't have any side effects.
1. JAMA Cardiology: Ablation or Drugs First


In this recently published JAMA Cardiology meta-analysis study, researchers pooled the results from 6 randomized clinical trials (RCT's). I should point out here that RCT's are considered the most accurate clinical studies as by randomizing the patients to say treatment "A" vs "B" it minimizes the risk of selection bias. And selection bias can change the results of a study if researchers subconsciously recommend one treatment over another based on how "sick" the patient may be.

With 1,212 patients from 6 RCT's available to study, these researchers came up with the following 3 conclusions:

1. Ablation is better at maintaining normal sinus rhythm.

2. Ablation results in less hospitalizations.

3. Ablation is every bit as safe as medications.

When I've shared the results of studies like these with patients, many have been surprised to learn that the safety profile of an ablation is similar to that of medications. And probably the reason why ablations are just as safe as drugs probably stem from the fact that we really don't have any good medications available to keep hearts beating in rhythm. All of the anti-arrhythmic drugs can change the electrical connections within the heart thereby ever so slightly increasing the risk of a cardiac arrest. Indeed, based on my 26 years of clinical experience since medical school, I've personally seen far more serious complications from AFib medications than complications from catheter ablations.
2. British Medical Journal Heart: Ablation or Drugs First
Interestingly, in this recently published meta-analysis researchers used the same 6 RCT's and the same 1,212 patients. Fortunately, when analyzing these same 6 studies, the researchers came to the same conclusion that ablations are best for keeping hearts in rhythm, keeping patients from being hospitalized, and from a safety standpoint there was no difference between the two therapies. In this world where everyone seems to interpret "the facts" differently, it is very reassuring that two different research groups came to the exact same conclusion.
3. Circulation Arrhythmia and Electrophysiology: Ablation or Drugs First
And in the third meta-analysis study published this year, the researchers writing this report only included 5 studies of ...

Is there a Low Carb Diet Mortality Risk?
Everyone seemed to think carbs were bad until this new study was published last week.  Is there a way to follow a low carb diet and still live a long life?  In this article, I'll teach you how to optimize your carbs so that you can avoid the low carb diet mortality risk.
The Dietary Carbohydrate Intake and Mortality Study
In what has to be one of the biggest carbohydrate studies ever done, Harvard University researchers included a total of 447,607 people.  Of these 447,607 people, a total of 46,464 people passed away during the 25-year follow-up of this study.  These Harvard researchers then analyzed their mortality risk based on food questionnaires filled out over the years prior to their deaths.  Here are the results:

1.  If you ate a moderate amount of carbs (40-70% of your total calories) you lived the longest.

2. If you followed a low carb diet (less than 40% of your calories are carbs), you lost about 4 years of life.

3. If you followed a high carb diet (more than 70% of your calories are carbs), you lost around 1 year of life.
How do you explain these results?
As carbs have been blamed for the obesity crisis, diabetes, and just about every other health problem, how can these study results be explained?  The answer is really quite simple.  Just as there are good and bad carbs there are also good and bad proteins and fat.

In the case of this study, people eating the most carbs ate a lot of flour and other processed carbohydrates.  As a result, their lives were cut short.  This fits nicely from what we know from countless other studies.

For the low carb eaters in this study, the problem is that they replaced their carbs with animal proteins and fat.  Indeed, these lost years of life could have been avoided had plant-based proteins and fat replaced their carbs.  Once again, this finding is something that comes up in study after study.

While nutrition studies are hard to do and sometimes reach the wrong conclusion, the results of this study seem believable based on what we already know.  Personally, I really don't think what percentage of carbs you eat matters provided you are eating a mostly real food plant-based diet.  In other words, if you choose to eat meat it is a very small portion of wild meat.  The bulk of what is on your plate is vegetables and you also have a healthy fat like nuts, seeds, avocado, etc.
How do you find out your carb percentage?
It is really easy to find out what percentage of your calories come from carbs.  Simply download the free version of either Lose It or Cronometer from iTunes or Google play to your smartphone.  If you still use a flip-phone, there is also a free desktop version to both of these apps.

Next, enter in everything you ate today.  Both of these apps will then automatically calculate what percentage of your calories came from carbs.
How to Eat Low Carb and Live a Long Life
Many of my patients swear by the ketogenic diet.  Some of the biggest celebrities in the world are also following the ketogenic diet.  Even my own carbohydrate intake this past week was 40%.  This 40% number was just 1% away from falling into the danger zone according to this new study.

Yes, you can eat low carb and still live a long life according to this study.  The way to do this is to replace your carbs with plant-based fat and protein.

For example, nuts, seeds, avocados, olives, and coconuts are all mostly fat.  Likewise, there is a lot of protein in beans, lentils, and other legumes.

The big take away for me from this study is that unless you want to eat more plant-based you should probably moderate your carbohydrate intake.  If you are trying to lose weight or reverse diabetes with the ketogenic diet, start embracing a much more plant-based way of eating...

Dr. Day's Riced Cauliflower Fast Food
It often seems like there is no time to prepare healthy food.  Wouldn't it be great if you could have great tasting healthy food in 5 minutes?  In this article, I'll share my riced cauliflower fast food meal.  This dish is guaranteed to fill you up for hours!
My "No Cooking Skills" Disclaimer
I am not a chef. In fact, I am horrible in the kitchen.   While my wife is a fabulous cook, I'm not.  If your time and cooking skills are limited, like me, you may want to consider giving this recipe a try.
4 Ingredients from Trader Joe's
We love Trader Joe's.  For those of you outside of the US, Trader Joe's is a popular and affordably priced health food store.  We have one between our home and my hospital.  While these four ingredients all came from Trader Joe's, you could easily improvise with your local health food store.
1. Frozen Organic Riced Cauliflower
While you could buy fresh riced cauliflower, I like the frozen variety better.  It is always fresh and I never have to worry about it going bad.  Given that it was frozen immediately, you don't get the loss of nutrients that often comes from long farm to plate transport times. I use the whole bag for this riced cauliflower fast food meal.
2. Frozen Melodious Blend
I love the frozen melodious blend from Trader Joe's.  There are only six ingredients with no chemicals, preservatives, or any added sugars.  The six ingredients are cooked green lentils, cooked red lentils, cooked green garbanzo beans, tomatoes, extra virgin olive oil, and sea salt. This little-frozen concoction is a meal unto itself.  I just use half the bag for this riced cauliflower fast food dish.  If you don't have a Trader Joe's near you, I would suggest substituting in one cup of cooked lentils in light olive oil.
3. Can of Organic Diced Tomatoes
I like the 14.5 oz (411 g) can of organic tomatoes (diced and no salt added) from Trader Joes.  I use the whole can which works out to be 1.5 cups of diced tomatoes.
4. Salt or Garlic Salt to Taste
I can't give you an amount because everyone's tastes and health needs are different.  You can make this rice cauliflower fast food dish with or without added salt.

If you choose to skip the salt, it will be a little bland.  Personally, I like to use garlic salt.  I like the added flavor that comes from the garlic.

I would suggest adding in a little salt or garlic salt and see how it tastes.  If you want a stronger flavor, add more.
Combining the 4 Ingredients
Preparation is simple.  Use the whole bag of organic riced cauliflower (12 oz or 340 g).  Add in half the bag of the melodious blend (or 1 cup of cooked lentils in olive oil if you don't live near a Trader Joe's).  Mix in the entire small can of diced organic tomatoes (1.5 cups, 14.5 oz or 411 g).  Then add salt or garlic salt to taste.

Given that most of the dish comes frozen, you can heat it on the stove or in the microwave.  I often throw the frozen bags and can of tomatoes in my computer bag when I leave in the morning as it is so easy to prepare everything at my hospital.  The total preparation time for me, including warming it up, is 5 minutes.
The Nutrition Stats
I eat the entire dish and it fills me up for half the day.  You could easily share this meal with a couple of other people.  Assuming you eat the entire dish by yourself, here are the nutritional stats.
Calories
Cauliflower 80, melodious blend 200, and tomatoes 90 for a grand total of 370 calories.  No other 370 calorie meal fills me up as much as this one does.  When you see how much food is in this 370 calorie meal you will be amazed.  Be prepared to use a huge container for this meal as it probably won't all fit on your plate.
Fiber
Cauliflower 8 g, melodious blend 11 g, and tomatoes 3 g for a combined total of 22 grams.

4 Reasons Why Vacations Make You Live Longer
Wouldn't it be great if the more vacations you took, the longer you lived?  Having just returned from a family trip I'd like to think that this week away added years to my life.  In a landmark study, researchers found that the more holidays you take, the longer you live.  In this article, I discuss four reasons why vacations make you live longer.
Vacation Longevity Study
In this study, researchers recruited 12,338 people who were at high risk for a heart attack.  Over the next nine years, they found something exciting.  If you want to live a long life, you need to take a lot of vacations.

Interestingly, the reason why these people lived longer was that vacations somehow protected them from heart problems.  Indeed, those taking the most vacations lived 17% longer and were 29% less likely to have serious heart troubles.
4 Reasons Why Vacations Make You Live Longer
To explain the life-extending benefits of vacations, these researchers came up with four possibilities.
1. Vacations Allow You to De-Stress
Really?  Perhaps this is because I have four strong-willed children.  In my experience, time away can be more stressful.  Everything from sleep deprivation to the various delays can make travel hard.

Perhaps the magic lies in the fact that it is a different kind of stress.  In my case, rather than the pressure of the operating room or being on call for hospital emergencies, it is now the stress of moving a large family from point A to point B and making sure my two-year-old doesn't get lost or injured in the process.

When it comes to stress and the heart, I have learned that you can't ever eliminate stress.  The only people without any stress have all passed away.  Whether or not stress causes you an arrhythmia or an early cardiac death all comes down to how you perceive your stressors.  Perhaps this helps to explain why any vacation related stress might be a good thing.
2. Vacations Increase Time with Family and Friends
Spending more time with friends and family may be one of the healthiest things we can do for our heart.  Indeed, studies show that your social life may be a better predictor of longevity than either smoking or obesity.  Sometimes it takes a vacation to wake us up to what is most important in this life.
3. Vacations Increase Physical Activity
Most people live their lives going from one chair to the next.  We sit for breakfast, sit in our cars, sit at work, sit in our cars again, and then sit to watch TV at night. Sometimes we need an enjoyable vacation to shake things up and get us a bit more active.

In my case, vacations offer the chance of a long workout.  And, as you know, long workouts can be challenging to come by during a typical workday. Physical activity from time away could be yet another reason why vacations make you live longer.
4. You're Working Fewer Hours
If nothing else, getting away means you aren't usually working.  And if taking a vacation makes it so that you avoid overtime then it may be good for your heart.  For example, many studies have shown that putting in more hours than the typical workweek significantly increases your risk of atrial fibrillation.  As a recovering workaholic, vacations help me remember the importance of creating memories that my children will remember for the rest of their lives.
How to Vacation Regularly on a Budget
Everyone's idea of the perfect vacation is different.  Rather than just settle for one big annual family getaway, we try to spread out many budget-friendly mini-vacations over the course of a year.  Our goal is to try and do something, even if it is just a one-night getaway, on at least a monthly basis.

Staying a couple of nights with old friends or family members can be another budget-friendly vacation.

4 Reasons Why Eating Nuts Prevent Atrial Fibrillation
Wouldn’t it be great if a handful of nuts could prevent atrial fibrillation?  In this article, I'll review the atrial fibrillation nut studies and share what I have learned from treating tens of thousands of atrial fibrillation patients over the last 23 years.
The Swedish Atrial Fibrillation Nut Study
If you are a nut lover, like me, then you’ll love this most recent study. In this Swedish atrial fibrillation nut study, researchers followed 61,364 people for 17 years.  After reviewing all of the data, they concluded that eating nuts decrease the risk of atrial fibrillation by 18%.

In order to get this 18% reduction in atrial fibrillation, the Swedes in this study had to eat nuts at least three times weekly for 17 years.  Sadly, they didn’t ask what kind of nuts they ate.  Thus, we have no idea if one nut is better than another for treating atrial fibrillation.

The most interesting part of this study was that the more nuts people ate, the less atrial fibrillation they had.  Unfortunately, the researchers only analyzed the data out to eating nuts three times weekly.  Based on the direction the graph was going, I suspect that daily nut eaters probably enjoyed even more atrial fibrillation protection.

While researchers did their best to make sense of the data, we can’t know for sure whether it was the nuts or the healthy habits of nut eaters that provided this protection.  To better understand whether nuts prevent atrial fibrillation, we need to look to other studies.
Two Other Atrial Fibrillation Nut Studies
In addition to the Swedish atrial fibrillation nut study, there have been two other significant studies looking at nut eaters and atrial fibrillation.  One of these studies showed that in male U.S. physicians, nuts offered no protection against atrial fibrillation.  The other study showed that while nuts, as part of an ancestral Mediterranean diet were helpful, they didn’t specifically prevent atrial fibrillation when compared to olive oil.
4 Reasons Why Nuts Could Prevent Atrial Fibrillation
I want to believe the Swedish atrial fibrillation nut study.  It only makes sense that nuts prevent atrial fibrillation.  Below are four reasons why it is possible that nuts prevent atrial fibrillation.
1. Nuts Are High in Magnesium and Potassium
Having optimal magnesium and potassium levels may be protective against atrial fibrillation.  As nuts are high in electrolytes, they could offer some protection.  Also, all of the other vitamins and micronutrients of nuts make a compelling argument as to why they might help.
2. Nuts Help You to Lose Weight
Despite all of the fat in nuts, studies show that these healthy fats help you to lose weight.  And as weight is so tightly linked to the risk of atrial fibrillation, it only makes sense that anything you can do to keep your weight in check would also help keep atrial fibrillation away.
3. Nuts Are Anti-Inflammatory
Our studies, as well as those from many other people, have shown that the higher your levels of inflammation, the greater your risk of atrial fibrillation.  As nuts help to reduce inflammation, you would expect that this would help your heart to stay in rhythm.
4. Nuts May Prevent Almost All Forms of Heart Disease
Depending on which study you look at, nuts have been shown to be protective against almost every form of cardiovascular disease.  Thus, given the incredible track record of nuts, you would expect that the same would be true for atrial fibrillation.
Nuts in My Atrial Fibrillation Practice
I wish I could tell you that all I have to do is prescribe a handful of almonds and atrial fibrillation goes away.  If the most potent antiarrhythmic drugs only have a fifty-fifty chance of keeping people in rhythm for even just a year,

Is Left or Right Side Sleeping Best for Your Heart?
Most of my cardiac patients sleep better on their right side.  Is right side sleeping best for your heart?  In this article, I discuss the science of behind right versus left side sleeping.
Gravity and Left vs. Right Side Sleeping?
Gravity plays a role in where the heart goes during sleep.  For example, if you sleep on your left side, then gravity will pull your heart toward your chest wall.  In contrast, gravity pulls the heart toward the center of the chest with right side sleepers. This subtle change in where gravity pulls your heart may affect symptoms, cardiac output, or even your heart rate.
Why Back Sleeping is Probably Bad for the Heart
If you are carrying any extra weight, back sleeping is definitely bad for your heart.  This is because when you sleep on your back, the extra weight collapses your airway (sleep apnea).  And studies show that sleep apnea dramatically increases your risk of heart failure and atrial fibrillation.

Stomach sleeping is another possibility.  However, as I have learned personally, stomach sleeping is a perfect recipe for neck and back issues.
4 Reasons to Sleep on Your Right Side
If you suffer from heart issues, talk with your doctor about whether you should sleep on your right or left side.  Based on the science, here are four reasons why you may want to consider sleeping on the right.
1.  Less Shortness of Breath
As far back as 1937 doctors have noted that heart patients breath better sleeping on their right side.  Indeed, the worse the cardiac function, the more likely people are to sleep right side down.  While the reason for this isn't entirely clear, it may have to do with a better venous return and lower pressures within the heart and lungs.
2. Better Cardiac Output
For the same reasons as number one above, cardiac output may be better with right side sleeping.  Once again, gravity pulling the heart toward the center of the chest may optimize cardiac performance.
3. Fewer Palpitations
No one likes the sensation that their heart isn't beating correctly.  As the heart is in the center of your chest with right-sided sleeping, studies show that palpitations become much less noticeable.  In contrast, when you are on your left side, the heart is pulled to the chest wall, and you may feel every irregular beat of your heart.

While many atrial fibrillation patients have noted that they have fewer arrhythmias when sleeping on the right side, I could find no studies supporting this finding.  Thus, when it comes to sleeping and arrhythmias, I suggest sleeping in whatever position that seems to help.
4. Lower Heart Rate and Less Sympathetic Nervous Activity
The sympathetic nervous system is the fight or flight response.  This fight or flight response makes the heart rate and blood pressure go up.

For most of my patients, sympathetic nervous system stimulation makes their heart failure, chest pain, or arrhythmias worse.  And when it comes to sleeping and sympathetic stimulation, studies show that right-sided sleeping may be better.
3 Reasons to Sleep on Your Left Side
Not everyone does best with right side sleeping.  In fact, there are three distinct groups of people that may do worse.
1. Acid Reflux Sufferers
People suffering from acid reflux may sleep better on their left side.  This is because studies show that acid reflux may be worse with right side sleeping.  Thus, if your acid reflux is causing you more symptoms than your heart, you may want to consider sleeping on your left side.
2. Vagus Nerve Arrhythmias
The vagus nerve connects the heart, brain, and gut.  Because of this connection, vagus nerve activation may be an important cause of arrhythmias.

With vagus nerve stimulation, you get increased parasympathetic activity which is the e...

Is Weekend Catch Up Sleep Healthy?
Getting enough sleep during the workweek is hard.  Wouldn't it be great if weekend catch up sleep could undo any damage from sleep deprivation?  In this study, I review a new study that goes against decades of sleep research.
The Longevity Plan
Ma Xue, one of the centenarians we came to love and know during our time in China's Longevity Village, taught a timeless principle.

"My life is simple. Because of this, it is easy to know when something is out of balance."

Sadly, our modern lives are usually a rhythmic mess. Indeed, when I see new patients whose hearts are out of rhythm, it is usually because their lives are also out of rhythm.  We’re generally not just out of rhythm in one way, but rather in multiple ways. And while we might be able to withstand a bit of disequilibrium in one part of our life, it’s hard to keep our balance when so many parts of our lives are so out of sync.

But starting quite simply, we can rebuild this balance piece by piece. And perhaps the best place is where almost all of us start each day, and where we end up each night.
Modern Life = Lack of Sleep?
Most of us wake up based on when we need to be somewhere, and from day to day that often changes. An early morning meeting can prompt a wake-up that is an hour or two earlier than usual. A late plane flight out of town can mean an extra few hours of slumber in the morning. And even if we keep a typical 9:00-to-5:00 workday, our five-days-on-two-days-off schedules promote sleeping timetables that are anything but routine.

Of course, very few of us are in a position to perfectly align our schedules to a sunrise-to-sunset existence. There are, however, things that almost all of us can do to bring a more consistent rhythm to our lives.  And while we work to bring our lives and our sleep into balance, fortunately, a new study just came out that offers hope.
Weekend Catch Up Sleep Study
I was amazed to read about a recent study looking at sleep duration and longevity.  After sifting through 13 years of records on 43,880 Swedes, they stumbled upon something that was rather interesting.

It should come as no surprise that these researchers found that those sleeping five or fewer hours each night increased their chances of dying early by 65%.  However, if these same sleep-deprived people could catch up by sleeping longer on the weekend, then their survival was as if they slept seven hours each night.  If this is true, it tells us that even if you have an incredibly demanding job, there is no longevity hit provided you can get some weekend catch up sleep.

I can't even begin to tell you how this study contradicts decades of previous research.  And, quite frankly, I need to see some additional research to convince me that these findings are actually correct.
The Dangers of Acute Sleep Deprivation
To understand how bad sleep deprivation is for us, we have merely to look at the time of the year in which almost everyone is simultaneously thrown off kilter: when most folks across the United States “spring forward” an hour to accommodate for daylight saving time, effectively losing an hour of sleep. On the Monday following the spring daylight saving change, the incidence of heart attacks rises 24 percent, and the impact continues on Tuesday, when rates drop only slightly to 21 percent above the usual rate.

A lack of sleep impacts us right down to the genetic level, affecting the expression of more than 700 genes, which in turn dictate everything from our rates of metabolism, to the way our bodies deal with inflammation, to the antibodies created inside our cells to deal with infections or toxins. Pulling just one late-night work session or just staying up to watch a single TV show leads to the release of some of the same biomarkers that are increased with a concussion...