Exploring Natural Approaches and Therapies for Atrial Fibrillation
Published Aug 28, 2013
One of the most common statements that I hear from patients is “I don’t want to take drugs, what are my alternatives? Are there any ways to treat atrial fibrillation naturally?” I do live in a state where there is a tremendous interest in natural therapies. Numerous herbal and nonherbal supplement companies are based in Utah. Also, there are many multi-level marketing companies that bring these therapies directly to your home. In this environment, it is not uncommon for me to be asked these questions multiple times in a day.
Most of the time patients are nervous about asking questions about nontraditional approaches in medicine. The nervous feelings often stem from fears of the physician not understanding or approving of alternative approaches or that these approaches may be in opposition to what the physician may want. In my practice I want my patients to feel comfortable discussing any matter with me. I want to learn about their use of herbal and nonherbal supplements. If they have a new agent that has brought them benefit, I typically will research it to learn more about the substance and the potential health related benefits or risks. In general the use of herbal and nonherbal supplements and alternative approaches to health care has increased dramatically, so it is important that patients and physicians discuss these therapies without any hesitation.
This background information gets me to my topic of this blog, what are the natural or alternative therapies available to treat or possibly prevent atrial fibrillation?
Avoiding substances that stimulate or irritate the heart
Caffeine: The most common approach my patients try when developing atrial fibrillation is to try and stop all caffeine intake. The most common sources of caffeine in my patients are sodas, energy drinks and supplements, and coffee. Many of these substances have not been directly studied to see if they increased risk of atrial fibrillation. However, there is extensive work looking at coffee consumption and risk of atrial fibrillation. In a large study from Denmark, 47,949 patients were followed for an average of 5-6 years. Across all levels of coffee consumption, the researchers did not find any correlation with risk of atrial fibrillation.(1) In a second study involving 33,638 healthy women who participated in the Women’s Health Study and were followed for an average of 14 years, again the authors found no association with caffeine consumption and atrial fibrillation risk.(2) So even though caffeine frequently can cause symptoms of palpitations and a sense of your heart rate being elevated, I have no evidence that links it to the development of atrial fibrillation.
Energy Drinks: One of the challenges in working with patients that enjoy energy drinks it that they often contain many ingredients that can stimulate the heart in combination with at times very large doses of caffeine. Many times in a year I will see patients that experience heart arrhythmias, including atrial fibrillation, after consuming energy drinks. Unfortunately, I have also cared for individuals that sustained a heart arrest while exercising and using energy drinks. When you look at the ingredient lists on these products there are often other known cardiac stimulants such as: tyrosine, phenylalanine, alpha lipoic acid, SAM-e, ginseng, tongkat ali, yohimbe, etc. These substances can have unpredictable effects on a heart under stress, such as with exercise. I would recommend avoiding the combination of intense exercise and consumption of these products to perform at a high level during exertion.
Over the counter weight loss products: Just like energy drinks, over the counter weight loss products often contain many different herbs and nonherbal ingredients that can act as cardiac stimulants and increase metabolism. Similar as the discussion with energy drinks, these products can have variable effects on the heart and as such have unpredictable heart risks. If you have experienced palpitations, chest pains, dizziness or other heart side effects, I would recommend to not use these products until you have consulted with your physician. If you are using these products and experience any new heart symptoms, I would again recommend discontinuing use and speaking with your physician. When you meet with your physician bring in the medication bottle so you can go over all the ingredients in detail.
Alcohol: Atrial fibrillation was noted over a century ago in a syndrome called “Holiday Heart”. In people that drank large quantities of alcohol, there is an increased risk of weakening of the heart muscle as well as fast irregular heart rhythms from the upper and lower heart chambers. Usually the heart condition stabilizes once the alcohol intake has stopped. Unfortunately with atrial fibrillation, even small quantities in susceptible people can cause an abnormal heart rhythm. Most of the time if alcohol is a trigger for your atrial fibrillation, when you keep a diary you will see a pattern between your use and the development of the abnormal heart rhythm shortly thereafter or within the next few days. Fortunately, in most people moderate consumption of alcohol does not result in a significant risk of atrial fibrillation.
Marijuana: Similar to alcohol, in some people recreational marijuana use can increase risk of atrial fibrillation. We will learn more about the true risks of marijuana use and atrial fibrillation as its’ use becomes broader for medicinal purposes.
Avoid High Doses of Vitamin D. Vitamin D is involved in how our body takes in and uses calcium. Our heart creates electrical impulses using common electrolytes in our body (sodium, potassium, magnesium, and calcium). With very high levels of calcium, the heart can more rapidly conduct electrical impulses. Atrial fibrillation is the conduction of very rapid electrical impulses at times upwards to 300 beats per minute in the upper heart chambers. When we examined body levels of vitamin D (derived from a blood sample) we found a much higher risk of atrial fibrillation in those patients with levels >100 nmol/L. Most of the time you have to take a lot of vitamin D to reach these levels, such as a dose of 10,000 iu or more per day. Sometimes you need these types of doses if you are deficient in vitamin D. My advice is if you are taking high levels of vitamin D, don’t stop, but contact your physician and have your blood level measured and the dose adjusted if needed.
Helpful herbal and nonherbal supplements
Fish Oil/polyunsaturated fatty acids: There are a lot of data available that suggests that fish oil can change the characteristics of the upper chamber of the heart and make it like likely to conduct atrial fibrillation. Also, people who consume fish regularly, typically a cold water species, have lower rates of atrial fibrillation and abnormal heart rhythms from the bottom heart chamber. High consumption of polyunsaturated fatty acids can produce favorable changes in our body’s cholesterol/triglyceride levels. As such, of all potential natural approaches, this seemed to be the best substance to consider. Unfortunately there have been a number of trials recently that have looked at polyunsaturated fatty acids use and the risk of subsequent atrial fibrillation in general and specifically after surgery. In all of these trials, the use of polyunsaturated fatty acids did not reduce risk of atrial fibrillation (3). As with many aspects of medical care, there is likely a role of upfront use of polyunsaturated fatty acids for the prevention of atrial fibrillation, rather than its’ use in the prevention of recurrences of atrial fibrillation after the abnormal heart rhythm is present. It also should be noted that type of fish may impact risk or in other words not all fish are alike. For example dark meat fish (Salmon, swordfish, bluefish, mackerel, and sardines) in one study increased risk, whereas other fish types lowered it (5). In users of fish oils keep cognizant on current research into the risk of prostate cancer with supplementation. This may be a previously unanticipated risk with fish oil use that may outweigh potential benefit.
Dietary fiber: In an interesting study of 4526 people that were followed for at least 4 years to look at diet and risk of atrial fibrillation, total fiber intake reduced risk of atrial fibrillation. In this study, total fiber was calculated from the cereals, fruit, vegetables, and legumes food groups. Depending on your use (stratified in quartiles for the study) you could reduce your risk of atrial fibrillation by 14-36% (5). These food sources have a myriad of other health benefits for gastrointestinal health, your cholesterol levels, blood pressure, and levels of body inflammation. The best way that I know to begin a very heart healthy lifestyle is to load up on whole foods in particular fruits, vegetables, and legumes.
Magnesium: As your body levels of magnesium decline, the heart can become more irritable and develop extra beats or abnormal heart rhythms. In a study of use of intravenous magnesium in patients with atrial fibrillation, the likelihood of magnesium being effective in treating the abnormal rhythm was 60% higher in comparison to patients that received a placebo agent alone. We often use magnesium supplements in patients that are experiencing extra or skipped beats. I am unaware of long-term trials that show magnesium supplements alone can reduce your likelihood of developing atrial fibrillation. Magnesium can build up in your body, so if you use supplements make sure you have your body level measured so it does not become excessive.
Anti-inflammatory herbal and nonherbal food sources: There is a lot of information available that shows that your level of body inflammation is associated with higher risks of coronary artery disease, heart attacks, heart failure, and atrial fibrillation. The higher your level of body inflammation (often measured by a common blood test called CRP) the higher risk you have of developing these complications. There are many food sources that are considered anti-inflammatory agents and have been shown typically in very small studies to reduce body inflammation. Most of these agents have not been directly studied as approaches to treat or prevent atrial fibrillation. So we are making a bit of a jump to say they will benefit your risk of atrial fibrillation. What we are assuming is that if inflammation and atrial fibrillation are linked, and a certain food source reduces inflammation, then the food source will reduce atrial fibrillation. In the complex environment of the body, such statements are often not completely true, but most of the agents I will describe I believe in general promote healthy living anyway.
1. Olive oil, avocado oil, grape seed oil versus vegetable oil
2. Green Tea
3. Dark Chocolate (or products with 70% or more cocoa)
5. Fish consumption (not fried) – see above discussion
6. Nuts – choose a variety such as walnuts, sunflower seats, almonds, pecans, etc.
7. Fruits – choose a variety such blueberries, cherries, raspberries, strawberries, pineapple, apples, etc, I heard important advice once that your plate should have a variety of colors or it is not diversified enough
8. Whole grain bread consumption is additive in lowering inflammation irregardless of your current lifestyle and diet (7).
9. Reduce your consumption of red meat
Any discussion regarding body inflammation would be incomplete without mentioning cigarette smoking. Cigarette smoking in even small amounts significantly increases body levels of inflammation. This risk includes to some extent exposure to second hand smoking. Regarding all of these lifestyle measures, stopping smoking is one of the best ways to lower your body inflammation.
Wenxin Keli: Wenxin keli is a Chinese herb that has purported benefits in reducing abnormal heart rhythms, body inflammation levels, and heart failure. Information on this herb is relatively new to us in the United States, but there are intriguing animal models that provide us with more understanding of its’ potential benefits. In a recent dog study, animals that received Wenxin Keli had their atrial fibrillation suppressed and were less likely to go back into atrial fibrillation or have it reinduced (8). What is exciting to me is that the heart rhythm effect was largely selective to the upper chambers of the heart, and as such, the drug was less likely to cause abnormal heart rhythms in the lower chambers of the heart; a common problem with current medications called antiarrhythmic medications used for atrial fibrillation.
Restoring an energy deficient atrium: The upper chambers of the heart in atrial fibrillation beat very rapidly and over time the muscle can breakdown and develop fibrosis and scar. The fibrosis and scar often become sources of additional atrial fibrillation. There are a few supplements that are aimed at keeping the energy stores in the heart elevated. Like many of the substances discussed, there are no formal studies to support their use in atrial fibrillation prevention or treatment.
1. Coenzyme Q-10: Coenzyme Q-10 is a naturally occurring enzyme in our body. When our heart is exposed to oxidative stress the cells can die (apoptosis) and cardiac fibrosis can develop. Coenzyme Q-10 protects the cells from oxidative stress (antioxidant) as well as the energy store houses of the cells, the mitochondria. In patients with heart failure, the use of Coenzyme Q-10 may improve heart function. Heart failure is often a consequence of progressive fibrosis and scarring of the bottom chambers of the heart. As such, there is reason to suspect there may be a similar benefit in the upper heart chambers. For now it is an unproven possibility, but it is an intriguing therapeutic option that needs additional study.
2. L-Carnitine: L-Carnitine is a non-essential amino acid that can be synthesized by the body. Carnitine transports fatty acids to the mitochondria of the cells to be utilized for energy. Carnitine is often used in a supplement form to boast energy. In our model, there is hope that be improving the energy stores of the upper chambers of the heart that scar, fibrosis, and disease progression may be reduced. In addition to supplemental L-Carnitine, we also get this amino acid in red meat. When we consume L-Carnitine, the bacteria in our gut digest t into a compound called trimethylamine-N-oxide (TMAO). TMAO has been shown in mice to cause atherosclerosis which is the primary mechanism behind heart attacks and narrowed coronary arteries. In vegans the amount of TMAO produced is much lower than in people that consume red meat (10). Not all studies with L-Carnitine show harm. However, with potential risk and no known benefit for atrial fibrillation, I would avoid its’ use for this purpose at this time.
Hawthorn: Of all the supplements I encounter, I find that hawthorn is used by my patients for just about every medical condition. For centuries Hawthorn has been used to treat problems with the circulation and respiratory systems. Hawthorn is an anti-oxidant and as such may have direct benefit to organs at risk from oxidative stress (free radicals) and cellular death and fibrosis. In a study of 143 patients with heart failure, patients that were taking Hawthorn reported less heart failure symptoms and had better exercise times on a bicycle exercise test (11). In another study of 2681 patients with heart failure, hawthorn preparations reduced the risk of sudden death (12). Hawthorn also has a positive impact on chest pain and may in the setting of diabetes reduce blood pressure. Many of these benefits may help reduce atrial fibrillation risk and recurrence. Use hawthorn after talking with your physician if you have atrial fibrillation. Many of the common medications used to slow your heart rate in atrial fibrillation are affected by Hawthorn. Examples include digoxin, metoprolol (beta blockers), and cardizem (calcium channel blockers). Also hawthorn may increase the effect of nitrates that are used for chest pain and as such can result in an unsafe drop in blood pressure.
Exercise in general promotes heart health, weight loss, lower blood pressure, and a lower risk of sleep apnea. Improvement in heart health directly reduces risk of atrial fibrillation. This is particularly the case if you keep your blood pressure under control throughout your life. High blood pressure is one of the most common causes of atrial fibrillation. Similarly, sleep apnea risk goes up with weight gain. In people with sleep apnea that is untreated, the risk of atrial fibrillation nears 50%. Avoiding the problem as much as possible by maintaining an ideal body weight is a very good preventative strategy.
The interesting aspect of exercise it that too much of a good thing, may not be a good thing. In male athletes with consistently low heart rates, there was a 60% increased risk of developing atrial fibrillation compared to men with heart rates that were higher (13). In a study of 52,755 long-distance cross country skiers, those that had shorter race times and those that competed in multiple events had the highest risk of developing atrial fibrillation. The authors observed a 30% increased risk in the most active athletic group (14). With exercise, moderation is a good thing. Look to minimize extensive training periods when your heart rate remains elevated for greater than 60 minutes a day. For those that need more exercise than this, do interval training in which rest periods are part of your routine. When autopsies are performed in extreme endurance athletes, there are small regions of scar and fibrosis in all chambers of the heart. These are the very changes we are hoping to avoid to decrease risk of atrial fibrillation (15).
There are two types of stress reduction to consider. First, the stress that we all feel related to living. This stress may come from our job, finances, relationships, local events, tragedies, etc. Stress causes people with and without known heart disease to have higher rates of abnormal heart rhythms from both the upper and lower heart chambers. I am not an expert in stress reduction, but there are many excellent sources available if you feel that you have too much stress in your life and if these stressful situations often result in the feeling abnormal heart rhythms. In general take time for yourself to engage in less stressful activities and work on your health.
Another important aspect to stress is that which our bodies feel at night. We need restorative sleep. This sleep helps maintain healthy heart function, the response of our blood vessels to the heart beats and blood flow, and to reduce the amount of abnormal heart rhythms we experience. Look towards ways to improve your quality of sleep. Improve your sleep environment. If you have sleep apnea, use your CPAP machine that will minimize body stress throughout the night.
An interesting study summarizes the importance of exercise and stress reduction. I think Yoga is great. I cannot do yoga, but I admire those that can. Yoga helps provide exercise, core stability, and also helps with stress reduction. In an interesting study of patients with atrial fibrillation, use of yoga reduced the amount of atrial fibrillation the recurred, lowered blood pressure, decreased depression and anxiety, and improved quality of life (16). If you can’t do yoga, consider moderate exercise that you enjoy and also an additional activity aimed at stress reduction.
Regarding anticoagulation that is required in most patients with atrial fibrillation, there are no proven natural substitutes. That is not to say that there are not substances that have anticoagulation properties, but to emphasize that none of these are reliable, predictable, and proven to prevent stroke if you have atrial fibrillation. In patients with atrial fibrillation, prevention of stroke is our primary concern. I would strongly suggest as you approach your atrial fibrillation, consider stroke prevention separately if you want to try natural therapies. The most common therapy used for stroke prevention is largely a natural therapy. It was originally discovered after cattle ate sweet clover and bled to death. The anticoagulant properties of sweet clover, used in much lower doses, were used to make warfarin (Coumadin). These same properties are found in many other plants. These anticoagulation properties are unique in their effect in different people and are strongly influenced by other drugs or supplements you may be taking. Warfarin requires close supervision by your physician so the dose you are taking is safe. At minimum, warfarin is an example of the challenges we face as physicians in using anticoagulation to reduce your risk of stroke, but at the same time keep you safe from bleeding risks.
In summary, there are lots of ways to approach atrial fibrillation. I think there are a lot of good preventative options and a lot of good alternative choices. Choose these options carefully and engage your physician as a partner so you can make the best choice for your health, happiness, and longevity.
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