Another nail in the coffin of the caffeine myth

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“There is a public perception, often based on anecdotal experience, that caffeine is a common acute trigger for heart rhythm problems,” said Peter Kistler, MBBS, PhD, director of electrophysiology at Alfred Hospital and Baker Heart and Diabetes Institute, and the review’s lead author. “Our extensive review of the medical literature suggests this is not the case.”

http://www.acc.org/about-acc/press-releases/2018/04/16/13/25/drinking-up-to-three-cups-of-coffee-per-day-may-be-safe-protective

Interesting. On an evening I'll definitely get less ectopics with a couple of glasses of wine. Maybe this is because as a vagal AFr the alcohol increases my sympathetic tone and accordingly heart rate. The trick is not to over-do it and end up with a vagal overshoot rebound in the early hours. Whilst ingesting coffee of an evening to try and get the same effect would obviously have adverse ramifications in terms of sleep, I might be a bit bolder through the day and give a cup or two a go. Coffee is something I've been avoiding this last 20 years just on principle based on everything I've previously read rather than personal experience. But as the article also states other than broadly generalising, if one clearly personally experiences some palpitation issues with coffee, then leave it alone.

Mike - another factor to the coffee issue that's not often mentioned is the toxicity of the beans that are not organic and are heavily pesticided to keep bugs and rodents out of the piles of beans stored and waiting for packaging and shipping out of the countries where grown. Since they are imported, they are also required to be fumigated by law before entering here in the US which adds to the toxic residue burden. Not sure if the UK does that as well.

But for afibbers who tend to be sensitive to chemicals, especially of the pesticide variety, then that can be a trigger when they drink coffee rather than from caffeine's stimulatory element. Of course, as usual, that association isn't recognized or addressed when discussing the health merits of coffee consumption.

Organic coffee has been reported here as tolerated by some afibbers and coffee does have the beneficial antioxidant properties when the beans are roasted at appropriate temperatures.

Jackie

"However, there may be individual differences in susceptibility to the effects of caffeine on the factors which trigger arrhythmias in some, and up to 25 percent of patients report coffee as an AFib trigger.

Patients with a clear temporal association between coffee intake and documented AFib episodes should accordingly be counseled to abstain."



Edited 1 time(s). Last edit at 04/17/2018 10:14PM by DavidK.

It never caused AF for me, but it always contributed to "jumpiness" - PACs and a general feeling of nervousness so I just learned to leave it alone. I never had a strong desire for caffeine so it was an easy choice.

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DavidK
up to 25 percent of patients report coffee as an AFib trigger.

People report all sorts of things as triggers based on a single correlation in time. I don't believe data based on self-reporting of triggers is valid.

Maybe, but we're all unique experiments of one and if repeated exposure to something consistently gives one more PACs/AF, then whatever it is IS a trigger for that person.

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Carey

up to 25 percent of patients report coffee as an AFib trigger.

People report all sorts of things as triggers based on a single correlation in time. I don't believe data based on self-reporting of triggers is valid.

Edited 1 time(s). Last edit at 04/18/2018 01:37PM by mwcf.

Individual trigger reporting is valuable in that it gives clues to people who may not otherwise know what to consider for what might be triggers. Many people are dumbfounded when they realize the many types of influences can be triggers and unless they have something as a guide or comparison, they often feel "lost" as to where to start.

Jackie

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mwcf
Maybe, but we're all unique experiments of one and if repeated exposure to something consistently gives one more PACs/AF, then whatever it is IS a trigger for that person.

Sure, but the key word there is "repeated." I specifically said people identify triggers based on a single correlation. I see that all the time on this and other forums.

Jackie, I was responding to the stat that 25% of patients report coffee as a trigger. It doesn't surprise me that they do, and I would bet that 99% of those people are wrong. They had a cup of coffee, shortly after they went into afib, and that was it. They drew a conclusion based on that one incident and never touched coffee again. So while an awareness that triggers can exist might be helpful for new afibbers, what's not helpful is the myths they're going to hear from people who drew unwarranted conclusions from a single coincidence, or even their own doctor who's just repeating a baseless myth he heard in med school 40 years ago.

I spent years looking for triggers just like everyone else, and when I identified a possible trigger I would actually test it. For example, I became convinced at one point that MSG was a trigger for me. So I went to the store, bought some MSG, and went home and drank a glass of water with a full tablespoon of MSG dissolved in it (a huge dose). Absolutely nothing happened, so MSG was ruled out as a trigger. I did similarly with everything I suspected, and one by one they all fell by the wayside. In the end, the only things I found that were reliably triggers for me were low potassium levels, dehydration, and excessive alcohol. From that experience I came to the conclusion there are far fewer real triggers than people think, and if they actually tested them they'd know that. So I don't encourage people to look for triggers. I think it's largely a snipe hunt.

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Carey
So I don't encourage people to look for triggers. I think it's largely a snipe hunt.

I disagree, and I do repeat testing like you do. Never a one-off. I also found that when I was consuming too much calcium from food, as I've previously reported, I was sensitive to many more triggerst than when not consuming the Ca++.



Triggers -

low Ca++: not consuming enough magnesium, overdoing endurance exercise (this was generally a delayed trigger and the amount of exercise is very significant - all day high heart rate - a couloir climb, for example)

high Ca++: the above plus, drinking a large quantity of a cold drink fast, getting prone on my left side, the time of fast heart rate drop after orgasm. Also the amount of endurance exercise required to be a trigger was materially reduced.

In my case, especially when consuming too much Ca++, the time between initiation of PAC's, which could quickly lead to afib, was very short (very near instantaneous). For example, after sex, I could feel the PAC's initiate. Many times I could ward off an episode by either sitting up or standing up and moving around (this would also work by changing position from prone on left side). Fortunately I have an understanding partner. And no, I didn't wait there and put on a monitor to see what the ECG strip looked like, I just took action.... (however I did try self-gratification with a recording monitor on, so I could capture the PAC's & they did happen then, too)

When I avoid these triggers, I almost never have afib. This is after a rocky start 14 years ago, including a 2.5 month episode in the first 4 months. I recall discussing this and my afib remission plan with my EP (and about fine tuning the electrolyte portion of it). He said using yourself as your own control was perfectly valid, from his perspective. I recall we discussed an "A", "B", "A" protocol for just this purpose somewhere in the distant archives here.

Afib can be very difficult to figure out. It took me 18 months to figure out the Ca++ connection. Before I figured it out, I thought I was ready to book a visit to Austin. Afterward, no need, at least at this time. I concur with Mike. While figuring out triggers may not have been fruitful for you, doesn't mean it is that way for all.

George



Edited 2 time(s). Last edit at 04/19/2018 09:05AM by GeorgeN.

George, you do realize that the average person cannot or will not follow regimes like you do and rigorously identify triggers, right?

Carey, I concur that George is indeed something of a 'one off' in terms of his determination and analytical abilities!

As for me I definitely consider MSG (or even excessive free glutamate) a trigger. Here's why.

Total 6 episodes this last 3 years. 2 of the 6 were a couple of hours after a Chinese takeaway, and I only had Chinese takeaway twice in that time period.

Another of the 6 happened 2 hrs after eating 2 x 125g bags of Snyders Jalapeno pretzel pieces (rammed full of MSG - helluva tasty though!).

Another of the 6 (my last birthday in March this year) after 2 days in Majorca eating nothing other than cured meats, strong cheese, pickles and red wine.

The most recent of the 6 was after a late rich all-day-cooked casserole meal, red wine and a 100g bag of pork scratchings an hour or two before bed = AF at 5am.

I think that somewhere in that lot is a strong hint that MSG/free glutamate is a trigger for me, and I definitely do not possess George's resolve or analytical skills!

As such, I now on a mission to avoid MSG/excessive free glutamate. Will it help? We'll see. Should I have tried harder to address this possible trigger years ago? Absolutely, but thus far my hedonism has had the better of me. If it doesn't then I'll be heading down the ablation route pronto. That said, avoiding MSG completely and minimising free glutamate can only help me towards better health overall regardless.

And believe me, whilst I've been here on this forum for 16 years, I've always - perhaps rather like your self - been a bit sceptical about triggers, but sometimes when there's incontrovertible evidence right there in your face then as such one ought to try and do something about it! In the old days this forum was all about triggers and trying everything one could lifestyle-wise to eliminate or at least reduce AF. Whilst the forum has these days shifted towards heading down the ablation route (and let's face it even former forum mod Hans went down the ablation route eventually), I still think discussing triggers remains valid providing, as you say, there is some reasonable degree of repetition involved.OK so maybe in the end, AF will always break back through owing to intrinsic predisposition towards AF, but if addressing triggers results in no more than a few hours total AF per year and pushes ablation a little further ways down the road then that's surely no bad thing.

George, loving the term 'self-gratification'!!



Edited 3 time(s). Last edit at 04/19/2018 03:57AM by mwcf.

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Carey
George, you do realize that the average person cannot or will not follow regimes like you do and rigorously identify triggers, right?

Ha ha ha, yes, having made my living analyzing and solving problems for ~40 years, I'm aware that I am different. A large part of my ability comes from persistence and patience. Afib is a very difficult problem. There have been some very bright, persistent people that have come through here over the years and their situations were such they were not able to solve the problem without an ablation, hence people should not feel bad if they can't solve it.

Some of my mottos:

If it isn't working, try something else.
Examine and reexamine the literature and the data to see what has been missed (this is what I did to figure out the calcium issue).

I have helped many people, both in real and virtual life. I usually will make a suggestion, but if it doesn't look like they will be able to follow through, I will suggest a trip to Austin or Bordeaux. While certainly not the majority, there are some who are up to the task and have benefited by trying the path less traveled. If someone is not successful after whole heartedly giving this a try, I do not suggest postponing an ablation. The remodeling cost is too great.

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Carey

(...) I spent years looking for triggers just like everyone else, and when I identified a possible trigger I would actually test it. For example, I became convinced at one point that MSG was a trigger for me. So I went to the store, bought some MSG, and went home and drank a glass of water with a full tablespoon of MSG dissolved in it (a huge dose). Absolutely nothing happened, so MSG was ruled out as a trigger. I did similarly with everything I suspected, and one by one they all fell by the wayside. In the end, the only things I found that were reliably triggers for me were low potassium levels, dehydration, and excessive alcohol. From that experience I came to the conclusion there are far fewer real triggers than people think, and if they actually tested them they'd know that. So I don't encourage people to look for triggers. I think it's largely a snipe hunt.

It's an interesting way to look for triggers! Usually, when thinking about a possible trigger, I would suspend it and, of course, I would likely get afib because there are some other triggers still acting.

Also, is it possible that triggers can change in line with our body chemistry? What was a trigger no longer is and vice versa?

No different than food tolerances. Always enjoyed eating nuts, especially pistachios. Now, I get a belly ache. Same could be said about triggers...no?

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Catherine
Also, is it possible that triggers can change in line with our body chemistry? What was a trigger no longer is and vice versa?

Yes, I'm sure that's true. Afib is a progressive disease. It changes over time, and other factors in our lives change over time. What worked for you a few years ago might not work next year, and what triggered your afib a few years ago might not trigger it next year.

Like I said, I think looking for triggers is largely a snipe hunt. The more useful thing to do is look for a solution for your afib that will prevent it once and for all without having to identify this, that or the other thing that supposedly triggers your afib. Fix the problem, not the triggers.

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Catherine
Also, is it possible that triggers can change in line with our body chemistry? What was a trigger no longer is and vice versa?

No different than food tolerances. Always enjoyed eating nuts, especially pistachios. Now, I get a belly ache. Same could be said about triggers...no?

That was certainly me with and without excess calcium in my system.

For me addressing MSG as undoubtedly the loudest and clearest trigger for me - during recent years and at the present time at least - is, I agree, likely not the magic bullet, but I'll take the other health benefits that'll go with it thanks. I recall Hans posting studies that said lone AFrs lived longer than non-AFrs. Whilst one might on-the-face-of-it think LoL to that, I can see how those with lone AF might well live longer PROVIDING they try and live as healthily as they can as by so doing they might offset and exceed the risks associated with AF in the bigger picture. Besides, I do have fond memories of snipe hunting on Tiree!

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Carey

Also, is it possible that triggers can change in line with our body chemistry? What was a trigger no longer is and vice versa?

Yes, I'm sure that's true. Afib is a progressive disease. It changes over time, and other factors in our lives change over time. What worked for you a few years ago might not work next year, and what triggered your afib a few years ago might not trigger it next year.

Like I said, I think looking for triggers is largely a snipe hunt. The more useful thing to do is look for a solution for your afib that will prevent it once and for all without having to identify this, that or the other thing that supposedly triggers your afib. Fix the problem, not the triggers.

George, reading through our comments, I’ve concluded the following: You try a regimen, it works for a certain time, then inexplicably it no longer does.

I feel for those of us who go through the rigors of ablation, only to have the bloody stalker reel its head, once more.

It is an illusive syndrome....a challenge.

Interesting discussion. My AFib "trigger" is simply getting up in the morning. I'm on Tikosyn (dofetilide) and Diltiazem. I feel like I can't wake up completely in the morning hours and I lapse into Afib with light-headedness. Then after lunch I feel great--no Afib symptoms period until the next morning. At lunch I always drink a Diet Coke. So today I decided to try drinking a 12 oz. Diet Coke (with a dash of lemon) along with breakfast. Voila. I almost immediately felt better, more awake, and the Afib symptoms/light-headedness dissipated. So the small amount of caffeine in the Diet Coke helped with my symptoms, yet I know from experience a cup of caffeinated coffee would be too much overboard. So yes, all of this symptom-managing is very much an individual thing depending on so many variables including, of course, all of the various meds we're taking. What seemed like "cheating" (drinking caffeinated Diet Coke at lunch) was actually something that was, in small doses, apparently helping. Go figure.