A6: As an afibber with an 8-year journey before ablation procedure, I can share a few of the findings that seem to hold true with "Lone Paroxysmal Atrial Fibrillation."
First, biochemical individuality comes into high consideration. No two afibbers have exactly the same symptoms or triggers nor do they respond identically the same to nutritional interventions or even rhythm or rate controlling drugs. It always seems to be an experiment of one to see which nutrients or drugs are compatible.
Once the pattern of when afib begins or what triggers it is established, the determination of either adrenergic or vagally-mediated afib tends to help select some avoidance patterns that help maintain NSR.
Identifying triggers is important. Alcohol is a known trigger for some; yet not all. It can be the alcohol or the sulfites, pesticide and fungicide residues in some wines - red more than white. Yet some afibbers do not tolerate any wine; some can drink organic wine. Others can drink beer but not hard liquor and vice versa.
Alcohol depletes magnesium. Sugar depletes magnesium and the "biggie " stress depletes magnesium and is almost always a universal trigger. Often not immediate, but a delayed reaction.
Regarding either alcohol or sugar intake, if the afibber tends to have even a slight tendency toward glucose handling dysfunction, the resulting hypoglycemia frequently triggers afib. Hypoglycemia in the middle of the night is a common trigger (from poor food choices earlier in the evening).
Adequate hydration with pure water is essential. Often afibbers report just that alone helped with the frequency of events. Since alcohol is dehydrating it's worth noting. Those afibbers who are heavy exercisers seem to benefit from carrying with them one of the electrolyte replacement powders similar to EmerGenC by Alacer.(not the one with the chemical sweetener) and not Gatorade which has high fructose corn syrup. In the hot weather, many of the afibbers forget to hydrate and replace electrolytes, especially on the golf course.
Afibbers are typically deficient in both magnesium and potassium but serum values of magnesium do not reflect the intracellular stores and both are extremely important when it comes to regaining and maintaining NSR.
It's important to measure ionized magnesium through the red blood cell magnesium analysis or the Exatest which is sublingual tissue cell scraping to evaluates the intracellular status of electrolytes. It is also important to keep IC levels of magnesium optimal and potassium also becomes critical because if low, the tendency is to shorten the refractory period which makes it easier to slip into the afib pattern.
Supplementing with potassium only (and not magnesium) can make afib worse, so better to replete with magnesium first and then add in supplemental potassium.
The most effective magnesium supplement most of us afibbers have found is the amino acid chelated version - magnesium glycinate using the patented process by Albion. This form does not break down in the stomach and become side-tracked with other combinations in the stomach's chemical soup, but rather arrives at the duodenum ready to go into the blood stream โ€“ intact and ready to work. Not only that, relatively high doses of magnesium can be required to reach IC optimization and this form of magnesium glycinate does not cause bowel intolerance issues until 1200 mg. daily and sometimes, even higher doses.
GI or gut issues become very important and can be highly instrumental in triggering afib especially in those with stomach acid issues, GERD or hiatal hernia. My personal experience involved a diaphragm adjustment that helped eliminated breakthrough arrhythmia while taking the antiarrhythmic flecanide. Any patient who tends toward having an acidic metabolism along with afib needs to alkalize daily through food selection and optimal electrolyte supplementation.
The additional use of amino acid, taurine, helps stabilize the cell membrane and keeps both magnesium and potassium in the cells and the excitatory electrolytes calcium and sodium out or at a synergistic balance.
A note about calcium supplements. Many afibbers who take supplemental calcium find that once stopped and optimal IC magnesium is reached, the AF events either stop completely or occur far less frequently. Calcium (excitatory) dominates the cell in the presence of magnesium deficiency and is often the culprit and we know the majority of the population is deficient in magnesium.. (Reference: The Magnesium Factor by Mildred Seelig, MD, MPH).
Both hypo- and hyper-thyroidism can be triggers for afib.
Dietary assessment becomes extremely important. Eating "clean" - that is whole organic foods (free of pesticide residues and toxins) plus avoiding packaged and processed foods that contain added chemicals for preservatives and flavor enhancers and 'natural' flavorings like MSG is a huge step in eliminating afib.
Artificial sweeteners such as Aspartame/NutraSweet and Sucralose/Splenda are notorious for triggering afib and all foods and drinks containing either should be eliminated.
Caffeine in coffee or drinks may or may not be a trigger. Some afibbers find they can drink organic caffeinated coffee; others cannot. Some can drink decafe; some cannot. Cola drinks or the spiked energy drinks are often typically triggers for the younger afibbers.
And cold drinks, especially, seem to be a trigger whereas room- temperature drinks are not; so avoid cold beverages.
Right along with the added chemical aspects of commercially-prepared foods goes the success that many afibbers experience when gluten containing grains are eliminated. Even if testing does not reveal gluten/gliaden sensitivity, afibbers have found success in following a Paleo type eating plan that eliminates all grains - with the possible exception using organic brown rice when they can't bear to give up all grains. Right along with that comes the elimination of dairy products since the casein protein often is just as irritating as the gluten protein.
The issues of silent celiac and the resulting irritation/inflammatory issues involved seem to be an important factor in controlling afib and it's something rarely addressed in conventional medicine. It the vagus become irritated in a person prone to afib, there will be an event.
The least expensive and easiest test to check for gluten sensitivity is to have the patient stop all grains and dairy for at least two weeks โ€“ longer if possible and take note of the symptoms or lack thereof. Often they note significantly fewer ectopy that lead to afib and many eventually to adopt the Paleo diet permanently. They can re-introduce one grain at a time but typically the symptoms repeat so dramatically that they go right back on the diet that eliminates the grain..or at least the gluten-containing grains. Many use organic brown rice.
In addition to the typical wheat, rye, barley, triticale, kamut and spelt, oats should also be avoided because even if said to be organic and free of gluten, the harvesting, transporting, processing and packaging, tends to leave the oats significantly contaminated with gluten. Assays have been made of organic oats from 'oats-only' facilities and even the majority of those were found to be contaminated. So.oats is out as well. That's why the Paleo plan is easy. No grains - period. http://www.paleodiet.com/
Additionally, I always used CoQ10 - at least 100 mg. daily to that I would also add D-ribose, especially when waiting out a prolonged event that might last longer than a few hours. And Omega 3 fish oils - 6 grams a day. I had/have a long list of those to help with heart energy, electrolytes, anti-inflammatory and anti-platelet aggregation. I found comfort in using Nattokinase rather than resort to warfarin or aspirin. But I always had a Plan B to use in case of a prolonged event - just for peace of mind.
There is no cure for afib. And, an absolute etiology has not been established either. Ablations and Maze procedures are often successful when done by the best electrophysiologists or cardiac surgeons, but they are invasive and carry the same risks of any similar procedure so for patients willing to try nutritional interventions and lifestyle changes, it seems a sensible approach to start with.
I'll be glad to share more of my experiences and protocols by email. As you can imagine, I have volumes of references and will gladly share.
Jackie Burgess, RDH, (retired)