If you’re diagnosed with atrial fibrillation, commonly known as AFib—a chronic condition that creates abnormal heart rhythms, increasing the risk for stroke and heart failure—your doctor may prescribe medications that you need to take for life, and, if that doesn’t work, advise a surgical procedure. Not only does each approach have risks, but in many cases you’re only controlling the condition, not treating the reasons you have it.
There’s a better way.
If you do it the right way, you can virtually reverse this life-threatening condition—while simultaneously dramatically reducing your risk for heart disease and diabetes, finds a new Australian long-term study. You may wind up needing no medications for this condition at all—and no surgery.
“The magnitude of the benefit has certainly been a surprise,” says Prashanthan Sanders, MBBS, PhD, director of the Centre for Heart Rhythm Disorders at University of Adelaide and the senior author of the study.
What is this revolutionary new treatment? It’s actually pretty old-fashioned—weight loss and managing the associated risk factors such as elevated blood pressure, blood cholesterol and blood sugar. But we’re not talking about quick weight-loss schemes here—and losing weight and then regaining a lot of it back can actually backfire, the researchers found.
The good news is that many of the participants in this research lost weight and kept it off for five years. There are lessons here for anyone who needs to lose weight for health.
For someone with AFib, it could be lifesaving.
THE 10% SOLUTION
Obesity is a well-established risk factor for AFib, but the Australian researchers wanted to know the long-term impact of weight loss on heart-rhythm control in obese people with AFib. They were specifically looking at how much weight loss was necessary to see benefits and what the effect of losing and regaining weight (a common occurrence in dieters) would have on AFib.
They studied 355 overweight or obese AFib patients, who were offered weight-loss programs, and followed in a weight-loss registry for five years. To qualify, a 5’10” man would need to weigh more than 188 pounds, although in practice the average weight for someone that height was 235 pounds. Some lost less than 3% of their starting body weight…others lost between 3% and 9%…and some lost at least 10% (an average of 35 pounds). Results…
- The 135 participants who lost at least 10% were six times more likely to be free from arrhythmia without any need for medication than 220 participants who lost less weight.
- Losing weight led to normal heart rhythms for many without any need for medication. That was true for 46% of those who lost at least 10% of their weight…22% of those who lost 3% to 9% of their body weight…and 13% of those who lost less than 3% of their body weight.
- Two-thirds of the patients who lost at least 10% of their weight were able to maintain the weight loss.
- Those who lost more than 10% of their weight had markedly better control of their associated risk factors.
- The benefits were drastically reduced in those whose weight fluctuated by more than 5%, possibly because repeated loss and regain causes physical changes in the heart and can increase the risk for high blood pressure and diabetes. Looking at all the participants, including those still taking medications, researchers found that 85% of the group that lost 10% of their body weight and kept it off were free of AFib—compared to only 44% among those whose weight fluctuated 5% or more.
Researchers don’t know exactly how losing weight improves AFib, but obesity causes a number of conditions that are all risk factors for AFib, such as impaired glucose tolerance, high cholesterol, hypertension and sleep apnea. Weight loss in obese patients reduces these risk factors. In fact, the study found that those who lost weight also had reduced blood pressure, better glucose control, lower cholesterol numbers and reduced inflammation. All in all, they were simply much healthier.
Results often happen quickly. With the loss of five or more pounds, “patients start feeling much better,” says Dr. Sanders. “Soon they notice they have less AFib and so they become more motivated.”
THE BEST WAY TO LOSE WEIGHT
In a time when the devastating long-term effects of The Biggest Loser are in the news, the study also demonstrated that losing weight and keeping it off for years is definitely possible—with the right type of program and support system. The weight-loss program in this study included motivational counseling in a physician-led weight-management program, with regular in-person visits to discuss goals, progress and outcomes—and extra visits if patients requested them. The diet was high protein, low glycemic and calorie-controlled. Most patients just adapted their own eating habits to the guidelines—only 1% to 2% needed meal replacements.
The first lesson was participation—those who followed up more often with the clinic staff were more likely to keep the weight off. Dr. Sanders believes the success of dieters depends on a few key factors…
- Individualization: Look at your own dietary habits, and identify where there is room for improvement. Keep a diary of your food intake and exercise. Specific diets were not the answer, found Dr. Sanders. It’s more a matter of where you can pare down your diet and how to avoid those foods that are causing trouble. For most people in the Australia diet program, the focus was on eliminating snacking between meals, reducing carbs and sugars, paring meal portions and limiting alcohol.
- Reasonable goals: Set achievable, progressive targets to provide a sense of success.
- Support system: It’s important to have someone to answer to or check in with. While the Australian study relied solely on physicians to help patients identify their problem areas, you can rely on a dietician or nutritionist, says Dr. Sanders. The subjects in the study met with someone once every three months, but those who were having trouble losing weight talked with or e-mailed their doctors weekly.
- Increased physical activity: This is important for everyone on a weight-loss program, but anyone with AFib needs to take special precautions. Talk first with your cardiologist and then, if given the green light, set small and achievable goals based on your current level of exercise. For example, if you’re walking 10 minutes a day, gradually increase so you’re walking 20 minutes on some days and work up to 30 minutes of brisk walking every day. In this study, participants were told to do low-intensity exercise for 20 minutes a day three times a week and then increase that to at least 200 minutes of moderate-intensity activity per week—50 minutes four days a week, for example.
- Regular medical evaluations—especially for medications. “While waiting for weight loss, make sure you work with your doctor to manage other risk factors that cause AFib, such as high blood pressure, diabetes, sleep apnea, etc.,” says Dr. Sanders. As your weight loss progresses, you may need lower doses—or be able to stop some medications entirely. “The treatment for these risk factors needs to be regularly evaluated,” says Dr. Sanders. “Often, with weight loss, patients can be weaned off.”
A NEW APPROACH TO AFIB
Currently, if you have AFib, your doctor will discuss medications and possible surgical approaches—and, if you’re lucky, mention lifestyle. The new research suggests that the order should be the opposite—the first line of treatment for someone with AFib is to treat the risk factors, including obesity, that led to it.
“I would work with each risk factor that is applicable for the individual, setting them achievable goals and supervise their management,” says Dr. Sanders. If after trying this you continue to have symptoms, then consider appropriate rhythm-control strategies—such as catheter ablation, in which tiny areas in the heart that are responsible for the abnormal electrical impulses are destroyed.
The good news: Even if you do need treatment, any weight loss you’ve achieved will likely improve your results. For ablation, for example, patients who lose weight and reduce other risk factors are five times more likely to have their hearts remain in a normal rhythm.