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Baltimore, MD


Doctors & patients are saying about 'Beat Your A-Fib'...


"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

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Adelaide, Australia

"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

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Dr. Wilber Su,
Cavanaugh Heart Center, 
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"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

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Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA


Prevention

Are Your Herbal Supplements Interacting With Your Medicines?

Many people take herbal or dietary supplements along with their prescription medicines. But medicines and supplements may interact in harmful ways!

Some supplements can decrease the effects of medicines, while others can increase the effects, as well as cause unwanted side effects.

The medicines affected have a ‘narrow therapeutic index’, which means that if the amount of the drug is even a little too low or too high, it can cause big problems.

Warfarin (Coumadin) is one such medicine. When taken with certain herbal supplements, such as Asian ginseng or St. John’s Wort (and possibly ginger), you may need to be closely monitored.

St. John’s wort, for example, interacts with many types of drugs. In most instances, it speeds up the processes that change the drug into inactive substances, leading to a decrease in drug levels in your body.

Other medicines with a narrow therapeutic index include digoxin (heart), theophylline (asthma), lithium (anti-depressant), acetaminophen (pain killer) and gentamicin (antibiotic).

The herb-drug interaction potential is high for St. John’s Wort, Asian ginseng, Echinacea, ginkgo (high dose) and goldenseal; But low for black cohosh, ginkgo (low dose), garlic and kava supplements.

Free download: Medication Inventory form at A-Fib.com

Medication Inventory form

Take an Inventory

If you take any of the described medicines and herbal supplements, use our free Medication Inventory form to make a list of everything you take.

List how often you take them, and the doses you take.

Then ask for a review by your doctor or pharmacist for any harmful interactions. You may find you want to modify your supplement regime.

Do Your Own Research

Learn more about herb-drug interaction potentials at:

Herb-Drug Interactions: What the Science Says. National Institutes of Health/National Center for Complementary and Integrative Health.
About Herbs, Botanicals & Other Products“ at the Memorial Sloan Kettering (MSK) website (one of our favorites).

Resources for this article
• 6 Tips: How Herbs Can Interact With Medicines. U.S. Department of Health & Human Services, National Institutes of Health, USA.gov. Last modified September 16, 2015. https://nccih.nih.gov/health/tips/herb-drug

• Davis SA, et al. Use of St. John’s Wort in potentially dangerous combinations. J Altern Complement Med. 2014 Jul;20(7):578-9. doi: 10.1089/acm.2013.0216. Epub 2014 Jun 23. PubMed PMID: 24956073.

• Chua YT, et al. Interaction between warfarin and Chinese herbal medicines. Singapore Medical Journal. 2015;56(1):11-18. doi:10.11622/smedj.2015004.

• Herb-Drug Interactions: What the Science Says. Clinical Guidelines, Scientific Literature, Info for Patients: Herb-Drug Interactions. National Institutes of Health/National Center for Complementary and Integrative Health. Last modified June 25, 2018. URL: https://nccih.nih.gov/health/providers/digest/herb-drug-science

• Jou J, Johnson PJ. Non-disclosure of complementary and alternative medicine (CAM) use to usual care providers: Findings from the 2012 National Health Interview Survey. JAMA Intern Med. 2016.Apr;176(4):545-6. doi: 10.1001/jamainternmed.2015.8593. PubMed PMID: 26999670.

Click image to go to her Personal A-Fib story.

Don’t be Fooled by the Numbers in Drug Ads: How You Get to the Absolute Truth

A while back we posted, Don’t be Fooled by Pay-to-Play Online Doctor Referral Sites, about how it’s common for doctors to pay io be listed in online doctor referral services. (Doctors can pay extra to be listed first in your database search results.)

How Some Drug Ads Mislead

This time we caution you about how some drug ads mislead you.

Here’s an example of an actual news report headline, “New Wonder Drug Reduces Heart Attack Risk by 50%.” Sounds like a great drug, doesn’t it?

Yet it sounds significantly less great when you realize we’re actually talking about a 2% risk dropping to a 1% risk. The risk halved, but in a far less impressive fashion.

A factual headline would be, “New Wonder Drug Reduces Heart Attacks from 2 per 100 to 1 per 100.” Doesn’t sound like such a great drug now, does it?

The online watchdog group HealthNewsReview.org reports, that’s why using “absolute numbers” versus percentages matter. “Absolute numbers” provide you with enough information to determine the true size of the benefit.

The Tale of a 50% Off Coupon

Professors Steve Woloshin and Lisa Schwartz of the Dartmouth Institute for Health Policy & Clinical Practice explain absolute numbers versus percentage (relative numbers) in a creative way.

“… [it’s] like having a 50% off coupon for a selected item at a department store. But you don’t know if the coupon applies to a diamond necklace or to a pack of chewing gum.
Only by knowing what the coupon’s true value is—the absolute data—does the 50% have any meaning.”

So, 50% off a diamond necklace might be a savings of $5,000. While 50% off a pack of gum might be 50 cents. Absolute numbers tell the whole story.

The Bottom Line: Be Skeptical, Ask Questions

As a healthcare consumer, it’s wise for you to be skeptical anytime you hear a benefit size expressed as a percentage, for example, a 50% improvement or 50% fewer side effects.

Read my book review

You should ask yourself 50% of how many? Of 10,000 patients? Or 10 patients? Which result is significant and which is just blowing smoke?

Numbers matter. That’s how you get to the absolute truth.

Additional Reading

See also How to See Through the Hype in Medical News, Ads, and Public Service Announcements, my review of the book “Know Your Chances―Understanding Health Statistics”.

The Math Behind a 50% Reduction

“New Wonder Drug Reduces Heart Attack Risk by Half.” How was this claim calculated?

The Raw Data: In the research study, the 5-year risk for heart attack for:

-a group of patients treated conventionally was 2 in 100 (2%) and
-a group of patients treated with the new drug was 1 in 100 (1%).

Absolute Difference: The absolute difference is derived by simply subtracting the two risks: 2% – 1% = 1%. Expressed as an absolute difference, the new drug reduces the 5-year risk for heart attack by 1 percentage point (or 1 in 100).

Relative Difference: The relative difference is the ratio of the two risks. Given the data above, the relative difference is: 1% ÷ 2% = 50%. Expressed as a relative difference, the new drug reduces the risk for heart attack by half, or 50%.

Absolute Numbers Versus Percentages:
How the numbers work (or mislead the reader)

Resource for this article
Tips for Understanding Studies: Absolute vs Relative-Risk. HealthNewsReview.org. Retrieved August 2, 2018.  URL: https://www.healthnewsreview.org/toolkit/tips-for-understanding-studies/absolute-vs-relative-risk/

Polypharmacy: A Cautionary Tale of Taking Too Many Prescription Drugs

Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported that 39 percent of those over age 65 now use five or more medications— a 70 percent increase over the 12 years tracking period.

“Polypharmacy” is the term for prescribing patients five or more medications at the same time (even if all are given for legitimate reasons).

This often happens when a person has many chronic diseases, such as diabetes, high blood pressure and heart disease, each requiring long-term treatment with medications.

What’s the Problem?

First, drugs are chemicals that can interact with one another with the potential to cause all kinds of complications (versus if you take just one medication).

Polypharmacy contributes to higher rates of hospitalizations and death, and higher costs.

For example, an anti-inflammatory medication like Ibuprofen (Advil, Motrin, Midol, Nuprin), may increase blood pressure and worsen kidney function. Therefore they should not be used by persons with high blood pressure or kidney problems.

Next, as we age, the kidneys and liver become less efficient in passing medications out of the body. The lingering drugs can magnifying their effects as well as have side effects.

Polypharmacy contributes to higher rates of hospitalizations and death, and higher costs.

Should You Be Prescribed Fewer Drugs?

Some people outgrow their medication. They change their lifestyle (ex. diet, physical activity, and weight loss) and subsequently may no longer need medications for diabetes, cholesterol or high blood pressure.

But they keep taking them, because no one told them to stop.

To ‘deprescribe’ a drug is not as simple as saying “stop”. It’s a process requiring caution and skill by your doctor.

Simple errors can occur, too. Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, recalled asking a patient to bring in every pill he took for a so-called ‘brown bag review’. He learned that the man had accumulated four or five bottles of the same drug without realizing it, and was ingesting several times the recommended dose.

De-Prescribing: A Brown Bag Review

Always keep an accurate and updated list of medications you are taking including over-the-counter drugs, herbal products, and supplements. Give your doctors each a copy. (See our free download form below.)

Periodically ask your physicians or pharmacist for your own ‘brown bag review’. Discuss whether to continue or change any of your regimens. Ask about:

▪ any medicines you no longer need?
▪ any medications you can do without?
▪ if a lower dose would work for any of your medicines?
▪ if any of your medications might interact with another?
▪ any non-pharmacologic alternatives?

If your doctor agrees to ‘de-subscribe’ a medication, realize it isn’t as simple as saying “stop” taking it. It’s a process requiring caution and skill by your doctor. (Afterwards, remember to update your list of medications.)

“We spend an awful lot of money and effort trying to figure out when to start medications and shockingly little on when to stop.”

Dr. Caleb Alexander, Johns Hopkins Center for Drug Safety and Effectiveness

Free Download: Keep an Inventory List of Your Medications

As a service to atrial fibrillation patients, we offer Free Reports, Worksheets and Downloads of our own worksheets and articles and useful free services or downloads from others serving the atrial fibrillation community.

Inventory List of Your Medications: We want to help you keep your doctor and other healthcare providers up-to-date on all the medications you are taking by using this Medications List from Alere.

Download and use to help you keep track of everything (including over-the-counter drugs, vitamins, herbs and mineral supplements, too). Remember to save the PDF to your hard drive.

Because your medications will change over time, print several copies of the blank form so you will always have a clean copy ready to use. (Keep in your A-Fib file or binder.) Give a copy to each of your doctors or other medical healthcare providers.

Resources for this article
• Kantor ED, et al. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA. 2015;314(17):1818–1830. doi:10.1001/jama.2015.13766

• Onder G, Marengoni A. Polypharmacy. JAMA. 2017;318(17):1728. doi:10.1001/jama.2017.15764 JAMA. 2017; https://jamanetwork.com/journals/jama/fullarticle/2661582

• Span, P. The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills. New York Times, April 26, 2016. URL: https://www.nytimes.com/2016/04/26/health/the-dangers-of-polypharmacy-the-ever-mounting-pile-of-pills.html

• Mishori, R. Why doctors should be prescribing less drugs. The Independent. 30 January 2017. http://www.independent.co.uk/life-style/health-and-families/healthy-living/prescribing-drugs-is-good-so-is-deprescribing-a7552971.html

• Jou J, Johnson PJ. Non-disclosure of complementary and alternative medicine (CAM) use to usual care providers: Findings from the 2012 National Health Interview Survey. JAMA Intern Med. 2016.Apr;176(4):545-6. doi: 10.1001/jamainternmed.2015.8593. PubMed PMID: 26999670.

• Qato DM, et al. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016 Apr;176(4):473-82. doi:10.1001/jamainternmed.2015.8581.

 

Vitamin K―Protection Against Arterial Calcification & Cardiovascular Disease

Most people get just enough Vitamin K from their diets to maintain adequate blood clotting.

But NOT enough Vitamin K to offer protection against health problems including arterial calcification, cardiovascular disease, osteoporosis, various cancers and brain health problems, including dementia.

The name Vitamin K comes from the German word “Koagulationsvitamin” where its role in blood coagulation was first discovered.

Vitamin K is an essential vitamin. It is one of the four fat-soluble vitamins, along with vitamin A, vitamin D, and vitamin E. It’s found in leafy green vegetables, broccoli, and Brussels sprouts.

Vitamin K and Vitamin K supplements come in several forms and can be confusing. To increase your levels of Vitamin K, it’s important to understand the differences.

Vitamin K Can be Classified as Either K1 or K2

Vitamin K1: Found in green vegetables, K1 goes directly to your liver and helps you maintain a healthy blood clotting system; keeps your own blood vessels from calcifying, and helps your bones retain calcium.

Vitamin K2: Bacteria produce this type of Vitamin K; it goes straight to vessel walls, bones and tissues other than your liver. It is present in fermented foods, particularly cheese and the Japanese food natto (the richest source of K2).

Different Forms of Vitamin K2

Making matters even more complex, there are several different forms of Vitamin K2. MK-4 and MK-7 are the two most significant forms of K2 and act very differently in your body.

MK-4 is a synthetic product, very similar to Vitamin K1, and your body is capable of converting K1 into MK4. It has a very short biological half-life of about one hour, making it a poor candidate as a dietary supplement. It remains mostly in your liver where it is useful in synthesizing blood-clotting factors.

MK-7 is a newer agent with more practical applications because it stays in your body longer; its half-life is three days, meaning you have a much better chance of building up a consistent blood level, compared to MK-4 or K1. It slows down cardiovascular aging and osteoporosis, and prevents inflammation by inhibiting pro-inflammatory markers produced by white blood cells.

Food Sources of Vitamin K and MK-7

Photo by Like_The_Grand_Canyon on Flickr licensed CC-BY

MK-7 is extracted from the Japanese fermented soy product called ‘natto’. You get loads of MK-7 from natto. However, natto is generally not appealing to a Westerner’s palate (can’t tolerate its smell and slimy texture).

You can also find Vitamin K2, including MK-7, in other fermented foods including some fermented vegetables.

Certain types of fermented cheeses (Jarlsberg) are high in K2 but others are not. It really depends on the specific bacteria. You can’t assume that any fermented food will be high in K2.

Besides broccoli, Brussels sprouts and leafy green vegetables (kale, mustard greens, collard greens, raw Swiss chard, spinach), other foods high in Vitamin K include beef liver, pork chops and chicken, prunes and Kiwi fruit, soybean and canola oil.

Vitamin K Supplements

Choosing a K2 supplement: When supplementing your Vitamin K food sources, consider a high quality MK-7 form of vitamin K2. (Plus, as they are inexpensive, include Vitamin K1 and MK-4 to help inhibit and possibly reverse vascular calcification.)

Relentless Improvement

Dosage: Although the exact dosage of Vitamin K is yet to be determined, one of the world’s top Vitamin K researchers, Dr. Cees Vermeer recommends between 45 mcg and 185 mcg daily for normally healthy adults.

My choice: I’m taking Relentless Improvement Vitamin K2 MK4 Plus MK7; Read about it on Amazon.com. David Holzman writes that he uses Whole Foods Vitamin K2 which is less expensive. (Use our portal link to Amazon.com and support A-Fib.com)

(If you have a K2 supplement recommendation, email me.)

Remember!
Always take your Vitamin K supplement with food that contains fat
since it is fat-soluble and won’t be absorbed without it.

Read more about mineral deficiencies and Atrial Fibrillation, see FAQs: Mineral Deficiencies & Supplements for a Healthy Heart

This article is based on Dr. Mercola’s article, New Study Shows Evidence That Vitamin K2 Positively Impacts Inflammation.
Resources for this article
Mercola, J. New Study Shows Evidence That Vitamin K2 Positively Impacts Inflammation. Mercola.com. October 12, 2013. https://articles.mercola.com/sites/articles/archive/2013/10/12/vitamin-k2-benefits.aspx

How Drinking Too Little Can Trigger Your A-Fib

Drinking too little alcohol? Coffee? Juice? No, we’re talking about just plain ol’ water. Drinking too little water leads to dehydration which can trigger an Atrial Fibrillation episode, and raises the risk for blood clots (it makes the blood thicker and more viscous).

Hydration Affects the Function of Your Heart

Your body contains significant amounts of water. A change in fluid levels in your body can affect a number of bodily functions, including heart function. When you have atrial fibrillation, drinking enough water is important.

Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.

When you’re dehydrated, your body’s electrolytes (electrolytes in general, and sodium and potassium in particular) are crucial for heart health. Electrolyte levels plummet when you’re dehydrated. This can lead to abnormal heart rhythm.

Dehydration Risk Factors

Your risk of dehydration isn’t just from sweating during exercise or from the extreme heat of summer. Other risks include high altitudes, the desert, exhaustion and increased stress, missing meals or a change in eating patterns and vomiting or diarrhea.

Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and less to keep ideal fluid balance.

Do you travel by plane often? Flying dehydrates you because the humidity level on a plane is usually less than 10%. Alcohol and caffeinated drinks also dry you out.

Cold weather can also dehydrate you. When it’s cold, the body works to maintain its core temperature, and works less to keep ideal fluid balance. And since you don’t feel thirsty when it’s cold, you often don’t think about drinking extra water.

The Good News, The Bad News

The good news is that usually dehydration on its own won’t cause an A-Fib episode. The bad news, when combined with other well known triggers, it will.plane-facing-right

For example, you risk dehydration when traveling by air (low humidity) during the hectic holidays (tired and stressed), drinking too much coffee (diuretic effect), and vacationing in the desert (dry climate).

Preventing Dehydration

Under normal conditions, 64 to 80 ounces of water per day is considered enough. On a plane, a good rule of thumb is 6 to 12 ounces of water (or club soda) for every hour in the air.plastic-bottle-and-sports-bottle-no-box-330-x-400pix-at-96-res

Be aware of the not-so-obvious signs of dehydration: dry mouth, constipation, feeling tired and sleepy, low urine output, dry skin and dizziness or lightheadedness. Furthermore, your body may misinterpret the need for water as the need for food making you feel hungry, when what you really need is more water.

Drink more water when… the weather is too hot or too cold, when traveling by plane, when you’ve skipped meals, when exhausted or you’re sick. For each coffee or alcohol beverage, have a glass or two of water.

Check your hydration level. Each body has individual needs for water intake. If you’re drinking enough, look at the color of your urine when you go to the washroom. If your urine is clear or light yellow, you are well hydrated. If it’s darker, you need to drink more water.

Be Aware—Stay Hydrated

Sometimes it’s the lack of a dietary staple that causes the heart to misfire, and in many cases, that substance is water.

As fatigue or muscle ache turns into thirst, you’re already pretty far down that path to dehydration. Many people don’t realize how quickly and deeply dehydration can set in, especially since the early warning signs are subtle.

Dehydration is never a healthy state, but the mineral imbalance that results can be especially troublesome for A-Fib patients.

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