How I’m Beating Atrial Fibrillation - And Why I Don’t Like Salt

I'm not a doctor.  I’m going to tell you in my own layman’s terms, in my own layman’s understanding, how I’m beating what once was persistent atrial fibrillation.

I don’t know exactly when it started, but by my mid 30s, I had persistent afib.  At routine checkups, the doctor might mention I had a little irregularity in my heartbeat.  The air of nonchalance in his or her voice seemed to assure me that some irregularity was normal.  I remember many times kneeling down in the aisles of Home Depot, looking at something on a low shelf, and getting dizzy after standing up, quickly looking for a safe place to fall if I fainted.  That's orthostatic hypotension – low blood pressure – a common symptom of a heart that isn’t beating efficiently.  One day I’d gone into the hospital at age 42 for a strange, debilitating illness that turned out to be mono, and upon intake, the nurse noticed my pulse was racing at 180bps.  Turns out that, on top of the mono, I was having an afib episode.  I spent three days in the cardiac ward as they monitored me, and when I was released, I had my first  cardiologist appointment scheduled for the following week.

At that first appointment, my cardiologist recommended electrical cardioversion.   I was awfully young to have afib, and maybe it was just a fluke, he thought.  That cardioversion was successful, but my afib came back after a little over a year.  During that year of no afib, I abstained from alcohol for the first six months.  I didn’t really change anything else because I assumed it was the alcohol that caused it.  I’d always drank a little too much and figured I was now paying the price.  Over the following few months I drank with friends a few times, and my afib returned in mid-day after a hangover beer and in the middle of a corned-beef sandwich.  That night before the afib reoccurred, I was eating salty foods because I thought eating salt was a good thing when drinking – it would help retain water and help prevent dehydration, I figured.

The second cardioversion required one more shock than the first time, but my heart went back to normal.  I told my doctor how it reoccurred in the middle of a salty corned beef sandwich, which I didn’t realize had a whopping 3000mg of sodium.  My doctor didn’t feel there was a connection, but I did.

Again I cut out alcohol.   Over the course of the next three months I drank twice, very minimally.  On a Thursday, sitting at my desk at 7:30am, on my second cup of coffee and while eating a sausage, egg and cheese biscuit, my afib returned.

I don’t know about you, but I can feel when my heart switches rhythm the very moment it does.  It’s like a panic attack that doesn’t go away.

At this point, my afib had been reocurring sooner and sooner between cardioversions.  Each time would be half the time before: over a year from the first one to the corned beef sandwich, five months from the second one to the sausage biscuit;  it seemed to be happening more and more often, and my cardiologist assured me it was useless to keep having cardioversions at this point.  He now recommended catheter ablation. 

Initially I was open to it.  I said “okay” to an appointment with the ablation doc.  During what was only a five-minute consulation getting to know the ablation doc, I was told there was a 60% chance of reoccurrence if I didn’t lose 20 lbs.  It was also typical to need 2.5 ablations to be “fixed”, I was warned.

I didn’t like what I was hearing. I’m sure most people wouldn’t either.  This is where I took matters into my own hands.    If I had to lose weight anyway, I may as well try now.  I’m 6’2” and during this time of my life, I would fluctuate in weight from 225 to 235.  The reoccurrences seemed to always occur when I was 235, which was also when I was eating my worst.

Facing the prospect of this scary-sounding surgery, I resolved to go all out.  I knew salt had something to do with it, despite what doc was saying.  I cut out all sodium possible.  Some days I’d have less than 100mg, others closer to 500mg.  Sources say that 500mg is the minimum requirement , but I’m of the opinion that not only does it vary by individual, but it varies by your saturation levels.  Think of how much sodium you’d get if you had to find your food in nature.  Zero.  That’s what you are meant to eat.  The FDA max of 2300mg of sodium is insanely high, and chances are you are already taking in or exceeding that level unless you are trying hard to avoid it.

I lost twenty pounds in roughly a single month just by sticking to salt-free stuff.  Vegetables, brown rice.  A low-sodium, low-carb tortilla wrap over salad was a huge treat.  A mushroom burger on Friday was even better – that 200mg of sodium in a hamburger bun is something you have to watch and limit.  Did it suck?  A little, but it would suck more to have a non-reversible surgery that would permanently weaken my heart, and have a 60% chance of reocurrance.  After a while, like anything else, you actually get used to not having salt.

Here Are The Villains

Sodium.   Sodium is an electrolyte and creates conductivity in tissue where it’s absorbed.   You don’t want to encourage conductivity when you have already-erratic electrical pathways across your heart.

Salt lies in places you wouldn’t expect.  Bread.  Butter.  Milk.  Prepared salads.  Carrots!  You have to start reading the labels.  Don’t assume something has no salt.  Quite the opposite: almost everything does.  Modern life has us so far removed from knowing what goes into our food, and our own ignorance wreaks havoc on our body.

Make sure you drink lots of water, especially when you’re eating foods with sodium.  Keep your sodium saturation levels low.

Electical affinity.  You may already know that afib is an electrical problem.  The pulses of electricity, from your nervous system, are sent across conductive tissues of your heart, making your heart “flex.”  Once the electrical pulses start crossing tissue, I believe there is an affinity for them to remain pulsing across that same pathway.  In my mind, that’s why once it starts crossing the wrong tissue path, it doesn’t reset without cardioversion.

Alcohol.  The first way alcohol damages your tissue is by dehydrating it.  Ever use rubbing alcohol on a rag and noticed your fingers looking dried out?  That’s what is going on inside your body, too.  What happens when you’re dehydrated?  Your sodium saturation goes way up because you’ve removed some of the water.

The second way alcohol damages your body is via inflammatory metabolytes like acetaldehyde.  Acetaldehyde is created as your body breaks down the alcohol.  This stuff is extremely inflammatory and as bad, if not worse, than the alcohol itself.  If you’ve ever been red and itchy after a night of drinking, this is one of the main reasons.

With continued alcohol use, you can imagine your tissues won’t be in great shape.  Inflamed and dehydrated, the heart muscle and its electrical pathways become less stable.

Caffeine.  It’s great at waking you up and putting you in a good mood, but caffeine cranks up the voltage of your nervous system.  It is also diuretic and dehydrates you.  Just like alcohol, this raises your sodium saturation levels and at the same time the stimulant aspect cranks up the voltage of your nervous system.  It also goes without saying, maybe, that any other types of stimulants – pill or plant – should be set aside too.  And hey, you might realize you’re less stressed without caffeine.  I did!

Weight.  When your rib cage is stuffed, all your organs are pressed together and become inflamed, and your plumbing (blood, lymph, digestion) can’t work efficiently.  The good news is, when you cut out salty food and alcohol, you will lose weight almost immediately.  I’m of the opinion that it’s not only the calories; consuming salt and alcohol impacts your physiology in a way that stifles your metabolism.

My story is like many.  I would drink recreationally, occassionally, and often to excess.  I’d drink coffee in the mornings – two cups.  During the 9-5 work week, by Thursday I was shot out and needed comfort food, so I’d have a high sodium breakfast – sausage and egg biscuit – sometimes a corned beef reuben at lunch.  The combination of those conditions – salt, caffeine, slight dehydration, and probably fatigue -- triggered my afib.

Take a fatigued, alcohol weakened, dehydrated heart muscle, add high levels of sodium saturation, crank up the voltage of your electrical system with some caffeine, and there you go.

On the day of my third cardioversion I went into the hospital weighing 205 (30 lbs lost in 2 months), eating zero sodium, on no medication whatsoever and with a bp of 120/80.   My whole life I had hypertension or pre-hypertension.  My whole life, it was the salt.

It has been two years since my last cardioversion, and I have had no reoccurrence of afib.  Every day, though, the danger of reocurrence is there.  I like to go out to eat.  I still have a few drinks here and there.  I’m at 215 now – slipping a little.  On days after drinking I am super careful to remain at ultra low sodium levels.  Caffeine is permanently out of the question – I don’t dare go there.   Well, maybe a little chocolate here and there, but never in the mornings.

You have to “listen” to your body.  Keep tabs on your pulse.  “Feel” your heartbeat.  I have become so focused on my heartbeat, I swear I can hear it in a quiet room.  When I eat a salty meal, I feel the effects and I feel a tightening around my heart.  I know if I continue to eat more salty stuff, I’ll be in the danger zone for afib to return.

What I like to do lately is eat zero sodium until dinner.  During the first half of the day, I’m more careful about eating salt or things which might containe caffeine.  I believe the heart and nervous system is more susceptible in the morning.   Blueberries, walnuts and unsalted peanuts are a morning staple.  So are unsalted hard-boiled eggs.  A mediterranean salad for lunch, with hardly any, if any, feta cheese, and no dressing, and go light on the olives (they are salty).  I reserve anything with sodium for later in the day – dinner time.  So you just have to be good the first half of the day.  It’s really not that bad!

Dinner:  When I first began my ultra-low-sodium journey, dinner was nothing more than a few scoops of plain brown rice with some onions and mushrooms mixed in.  If I was really hurting for some flavor, I'd stuff that in a tortilla wrap - the lowest sodium one I could find.  Lately, if I'm eating in, I will make dinner with as minimal sodium as possible – usually there is a lot in a tortilla, in the salsa or spaghetti sauce, or in the canned beans (the low-sodium kind), which gives any meat that  accompanies it some flavor.  Given I haven’t had any salt all day, this is still powerful stuff: while most would think it bland, it’s plenty salty for what I’m used to.  The less you are used to, the less you need to get the same effect.  If I go out, I eat pretty much anything on the menu (well, still not touching that corned beef reuben).  Afterwards I commit to not eating out the next day or so, and have to be more careful with my salt intake.  Sodium saturation rises and falls, and most importanty, it accumulates.   If I have alcohol, I walk on eggshells the next few days – getting plenty of water, and as little sodium as possible.  On vacations, when we do eat out a lot, I feel the salt buildup as tension in my chest beginning to build.  I stay very aware of how my heart is acting.  You must listen closely, figuratively speaking.

I want to close by saying, “this is what has worked for me.”  Your body and your situation may be different, but if you haven’t at least tried an ultra-low sodium diet and avoiding caffeine and alcohol, you might consider it.  Not only will it possibly reverse your atrial fibrillation as it did mine, but your overall health should improve greatly. The standard disclaimer of “this is not medical advice / check with your doctor” applies here; remember you do need some sodium to survive.  Just stay aware of what’s in your food and you will see you probably already get plenty of salt, even as you try to avoid it.

And finally, my afib didn’t reset itself without a cardioversion.  It may have eventually converted without intervention after a few more months of these new, good habits, but my final cardioversion appointment was already scheduled at the time I adopted this diet.

Since I’ve changed my ways, afib has not returned, and I’m confident that it won’t, as long as I remain dilligent.  I no longer need a catheter ablation, my blood pressure is great, and I feel great about the positive effects this lifestyle change has brought to my body.  I am hopeful that my story can help and inspire others.

Thanks for reading.

- Brian

Post Script and Disclaimers

What I have written here is not medical advice, and you should not take it as such.  Consult your physician before making any changes. This is my personal blog and these are my personal opinions, as they apply to my life.  Consider this a sharing of my life experience.

All of my assertions will be debatable.  They are not necessarily scientific or backed by medical research, but they are what I’ve observed first hand, and are expressed in my own words.  My ability to control atrial fibrillation by applying these assertions does seem to reinforce their credibility, but I am but one data point in a sea of many.

Catheter ablation is a $300K insurance bill.  I imagine it’s a service that hospitals love to provide.  Don’t forget, a hospital is a business too.  Not saying it isn’t a useful and potentially necessary procedure, but you might want to weigh money motivation as a factor in your individual decision.  The world is full of things that aren’t always as pure as they seem.

An article on salt as a potential afib trigger.  I haven’t gone hunting for articles to support my position; I’ve proven to myself what has worked – good, old fashioned, healthy eating.  Nothing new here.

Salt as a Trigger for Atrial Tachycardia/Fibrillation
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302945/

A devil’s advocate article stating that coffee is “good” for afib.  I don’t think so, but maybe everyone’s different.

Coffee Consumption and Risk of Atrial Fibrillation in the Physicians’ Health Study
https://www.ahajournals.org/doi/10.1161/JAHA.118.011346

How Much Salt Do You Need To Surive
https://www.livescience.com/61855-how-much-salt-do-you-need.html