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Atrial fibrillation, or Afib, is the most common clinical arrhythmia––meaning abnormal heart rhythm––affecting millions of Americans, recognized as a global public health problem due to its significant burden of death and disease resulting from stroke, heart attacks, and heart failure. Is there any particular diet that may help prevent or treat it?

Well, recently we learned what not to eat. Low-carb diets are associated with increased risk of developing atrial fibrillation, for a variety of reasons. First of all, people on low-carb diets may be eating fewer anti-inflammatory foods like vegetables, fruits, and whole grains. Reducing intake of these anti-inflammatory foods may be one of the important mechanisms for the risk of getting Afib. Secondly, a low-carbohydrate diet means increased protein and fat consumption, which may stimulate oxidative stress––the formation of free radicals, which was also demonstrated to be associated with Afib. Finally, the effect could result from the increased risk of other cardiovascular disease, which can set you up for Afib. And indeed, low-carb diets are associated with an increased risk of overall mortality, dying from any cause, as well as specifically dying from cardiovascular disease, and dying from cancer.

Dietary recommendations for patients with heart rhythm disorders is essentially the opposite of a low-carb diet, centered on a day-to-day basis around fruits, vegetables, grains, beans, and nuts, with seafood at most a few days a week; eggs, dairy, and chicken on more like a once-a-week basis; and other meat on more of a once-a-month basis, in part because we’re trying to cut down on saturated and trans fats.

Whole food, plant-based diets emphasizing whole grains, legumes (beans, split peas, chickpeas, and lentils), vegetables, fruits and nuts, and excluding most (or all) animal products may play a special role, as they not only maximize protective foods, but also exclude potentially harmful animal foods. For example, there is persuasive evidence that avoidance of certain foods may beneficially affect atrial fibrillation––such as the avoidance of dark fish and alcohol.

The dark fish thing comes from the Framingham Heart Study. By dark fish, they mean salmon, swordfish, bluefish, mackerel, and sardines. And they found in an exploratory analysis that those participants who consumed more than four servings of dark fish, like salmon or sardines, a week were at a whopping six-fold higher risk of developing Afib––though the intake of fish in general didn’t seem to have any effect.

We’re not exactly sure why alcohol is so bad when it comes to arrhythmias, but we might have as much as an 8 percent increase in the relative risk of Afib associated with each drink one might have per day––though drinking coffee, or caffeine in general, does not seem to be related to arrhythmia risk.

Where plant-based diets really shine, though, is in Afib risk factor management. Plant-based diets may reduce the likelihood of many traditional risk factors that are associated with Afib, including hypertension, hyperthyroidism, obesity, and diabetes.

High blood pressure is one of the major risk factors, accounting for about one-fifth of all new cases of Afib, which is where a plant-based diet can come in: improving vasodilation, the ability for your arteries to expand naturally, in addition to the anti-inflammatory and antioxidant effects, and increased potassium intake, and decreased blood viscosity or sludginess.

In terms of hyperthyroidism, excluding all animal foods from one’s diet was associated with half the prevalence of hyperthyroidism compared with those who eat meat, with vegetarians and fish-only diets associated with intermediate protection.

Having excess body fat may be responsible for about another fifth of all Afib cases, but the good news is significant weight loss is associated with a six-fold greater freedom from atrial fibrillation. You can see that those with Afib who started out overweight, but lost 10 percent or more of their body weight, five years later, only 10 percent ended up with Afib, whereas those who lost less than 3 percent or gained weight, 60 percent ended up with Afib––six times more.

Here are all the atrial fibrillation risk factors that can be prevented, arrested, or even reversed with a healthy enough plant-based diet. High blood pressure, type 2 diabetes, obesity, systemic inflammation, and heart disease. In light of these findings, dietary modifications are of paramount importance. But you don’t know if it could actually cure atrial fibrillation, until you put it to the test.

Unfortunately, all we have are case reports, but this one is quite compelling. An 82-year-old man presents with polypharmacy, meaning on a bunch of different medications, due to coronary artery disease, a heart attack history, ischemic cardiomyopathy, high cholesterol, high blood pressure, and persistent atrial fibrillation, who presented with memory loss, cognitive impairment, fatigue, and weakness. Now, if you’re not going to change the diet and lifestyle that led to all the problems in the first place, then drugs can certainly be better than nothing. Yet, commonly used blood pressure and cholesterol-lowering medications provide actually little absolute risk reduction and pose significant risk of adverse effects, as I’ve explored before. So, this guy decided to start treating the underlying cause. So, he started a whole food, plant-based diet with moderate physical activity, resulting in a rapid reduction of high cholesterol and high blood pressure, and the discontinuation of statin, antihypertensive, and beta blocker drug therapy. The patient also reported reversal of impaired cognition and symptoms associated with atrial fibrillation and ischemic cardiomyopathy, including light-headedness, fatigue, and weakness.

Check out these numbers. Started out on all his medications. Started eating healthier in February, and his LDL bad cholesterol dropped 37 percent down to 72. And you say yeah, but he’s still on cholesterol-lowering statin drugs. But even after his doctor discontinued it and his blood pressure meds, his cholesterol stayed down, and his blood pressure completely normalized. Okay, but what happened to his atrial fibrillation? Completely resolved.

Here’s how the patient described it. “In December 2017, I suffered a near-fatal heart attack and was rushed to the hospital. I immediately had a stent put in. The following day, I was prescribed a number of drugs to manage my condition. My brain fog got worse, and I felt tired all the time. I decided enough was enough. I had already lost four years of my life to medication-induced brain fog. I wasn’t going to sacrifice more. I had been eating a wholesome Mediterranean diet, but I was then educated on the benefits of cutting out all the crap. And now? I have the strength to lift weights and walk and run on the treadmill an hour every day. I feel more alive than I have for years. I wake up each morning with a clear head and happy heart, grateful to not have to take a handful of drugs. Even though I’m not perfect with my diet, I’ve seen huge benefits from eating this way. My blood tests have shown remarkable improvement, which keeps me motivated to stay on track. Because of my improvement, my cardiologist suggested I could let go of his last remaining drug. Eating this food gave me an opportunity to reclaim my health.”

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