Anorexia

Curious of experiences - firsthand or otherwise - dealing with AF and anorexia. Specifically, did the AF burden improve after normalizing body weight/chemistry (and addressing the underlying eating disorder)?

There are many studies citing the link with heart arrhythmia and eating disorder, but nothing specific to improvement of AF after treatment.

I am asking for me, I have been dealing with the eating disorder for 6 years, AF for 3. Former cyclist. Currently 39 years old, hoping this could be part of my issue. PM if you do not want to post to forum, I know this can be a personal topic.

I don't know of any research in this area but it wouldn't surprise me at all if afib could be a consequence of anorexia. Will it improve after normalizing your eating habits and getting your body back in order? It's possible but I don't think it's predictable.

You mention being a former cyclist. How hard core were you and for how long? Like how many miles per week at what speeds? Endurance sports are another risk factor for afib, and it's possible the cycling plus the anorexia was kind of a double whammy.



Edited 1 time(s). Last edit at 01/03/2020 12:07AM by Carey.

Typically 15-25 hours a week of training. Retrospectively, I can 'easily' trace (what I think) the path to AF. For me, IMO, this was too much time just below and at AT/LT, plus poor recovery, diet, sleep - and chronic overtraining! I raced domestically as a pro.

I am well aware of the connection of endurance training to AF. However, I believe there are some simple things which can be done to help prevent as much of this as possible. This includes proper recovery, nutrition, training methodologies and more.

At this point, I am most interested in how to 'reverse' the AF .

I have no data, but I could envision that anorexia could have a negative impact on electrolytes and certainly for some of us, the electrolytes have a huge impact on having or not having afib.

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GregH
At this point, I am most interested in how to 'reverse' the AF .

You and almost everyone else who visits this site.

I'd say the most obvious first step for you is getting your eating disorder under control and getting your body back in a normal status. Once you're there, you can work on the afib. Maybe it will settle down on its own once you do that.

Just an off the cuff observation - It seems that from what I have seen/read, endurance athletes that get afib get later in life 50's - 70's. This may not be true, but I don't recall any athletes in training, or shortly there after, getting afib. For me, afib showed up at age 50. Endurance training ended at age 23.

Ken - in my experience, based on the athletes I know and doctors I see, there is a decent group of people aged 30 - 50 who have this. In fact, Currently, there is research being conducted looking at AF by way of 'endurance' vs. hereditary and the different risk factors, treatments, interventions.

THIS is one example of cyclists/triathlete who have had AF and returned to sport.

I am sure most of you have seen this study (and the corresponding studies it sites): [www.ncbi.nlm.nih.gov]

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GregH
Ken - in my experience, based on the athletes I know and doctors I see, there is a decent group of people aged 30 - 50 who have this. In fact, Currently, there is research being conducted looking at AF by way of 'endurance' vs. hereditary and the different risk factors, treatments, interventions.

THIS is one example of cyclists/triathlete who have had AF and returned to sport.

I am sure most of you have seen this study (and the corresponding studies it sites): [www.ncbi.nlm.nih.gov]

Greg,

I concur, certainly a number of athletes profiled in this article were fairly young when they presented.

I was an ordinary recreational athlete - nothing at the level of you or Ken (a former Olympic swimmer). I'd played American football in college and maintained fitness my whole adult life. I'd run in high-altitude half marathon's with a lot of elevation gain (ending over 14,000'). Still I didn't train that hard by comparison. My first episode was at age 49, I'm now 64. I was lucky enough to have a cooperative EP and to create a program for myself that has kept afib episodes minimal - after a 2.5 month episode that started 2 months after the initial one. Electrolytes and exercising at the correct intensity, for me, have been my keys, as has on-demand flecainide when I did have afib.

I think a lot about what is optimal exercise. For years, it was just subjective. For me, it was the product of intensity times duration that was the trigger. More recently, I've tried to quantify it as my 32 year old son-in-law presented with afib 4 years ago. I've been coaching him to try to help him have a very low AF burden. He is in the military, so staying fit is part of the job. I recently wrote about my suggestions to him here. Looking at Dr. Maffetone's MAF program as well as Dr. San Millán's Zone 2 program (both linked in my post), I think staying within the bounds they suggest may avoid the right side of a J or U shaped risk benefit curve with respect to exercise, at least as far as afib goes. That is my hypothesis for myself and my son-in-law anyway. Of course everyone is different and how much remodeling has occurred will impact whether this level is too much for some. For myself, if I'm not wearing a heart rate monitor or sampling lactate, my simple answer is to just always keep at a level to breathe through my nose. I can do Tabatas, as the intensity by itself is not a trigger for me, just the intensity times duration.

Electrolytes, for me, have been also key these last 15 years. My program is magnesium (any form) to bowel tolerance, 2 tsps of potassium citrate powder (about 4 grams of potassium) plus 1/2 tsp salt (NaCl - a 4:1 K:Na ratio) in a liter of water consumed over the day (my version of timed release potassium), no concentrated calcium intake (cheese had a negative impact at one point) and 2-4g (1/2-1 tsp) of taurine powder. This seems to also be working for my son-in-law. He also had an issue with periodically over consuming alcohol, which also was a trigger for him. He's quit that for now. I suggested he should find a place where he had no afib, and then see what he could get away with.

I've often wondered what changed at age 49 for me with respect to magnesium. I have no answer, as my bowel tolerance is high (3 or more grams), whereas 800 mg works for my son-in-law.

My hypothesis is that there is a genetic component for those of us whose path to afib is chronic fitness. While there are certainly a number of us, we are by no means the majority of those who are chronically fit. In 2003:
Researchers at the Cleveland Clinic report that autopsies of the myocardial sleeves of pulmonary veins in five atrial fibrillation patients revealed the presence of P cells, Purkinje cells, and transitional cells similar to those found in the heart’s conductive (nodal) tissue. Conductive cells were not found in five control patients without atrial fibrillation. The researchers point out that whether or not these conductive cells are involved in AF still needs to be determined.
Journal of Cardiovascular Electrophysiology, Vol. 14, August 2003, pp.803-09 This might be a genetic smoking gun.

Hey George, thanks for the insights. I have friends who are great with meds, others who are doing only HIIT training, others who are more Z2/ fatmax based (Leonard Zinn has written a bunch about this) and going over this zone results in AF. The challenge is the individuality, and what works for one person, may be the kryptonite for the next. Its great we can all share experiences and help explore ways to help us live the best lives possible.

One note on lactate - Peter Attia and others (this was not discussed in his interview w/Inigo) often misrepresent the zones with regard to actual measurement of lactate. MLSS/AT/LT can vary from athlete to athlete. Some can be at 2.7 and be at MLSS, while others can be at 6.0 mmol. This means 1.3 to 2.0 mmol may not be Z2/Fatmax/etc...if you do not have a complete metabolic profile of the athlete and understand where they are combusting maximal fat and combusting max lactate. Hand held devices are not the most accurate, and this is magnified at lower levels. If the accuracy is +/- 5% this is magnified at lower levels vs above LT...which is why testing athletes is best done at and above LT, due to the steeper lactate curve and increased accuracy. A good example - power at a lactate level of 2.0 mmol could be 220 watts. Power at 2.5 mmol could be 270 watts. If this was above LT...call it 375 watts at 4.5 mmol and 6.0 at 400 watts. The steeper the curve, the more accurate.

In testing athletes who do lots of high intensity, they can exhibit higher lactate levels at LT (5 or 6 mmol), due to poor development of the aerobic metabolism - due to majority of time spend at or above AT. Since lactate is combusted by the aerobic metabolism, this system is underdeveloped. For an athlete with a AT/LT of 300 watts, their fatmax might. be 160 watts, as an example (could be 220 watts). This would also be the point at which they are combusting the most lactate (combustion of lactate looks like a bell curve starting at rest, peaking in the 'middle' and obviously getting pretty low at LT, and then accumulating above LT).

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GregH
One note on lactate - Peter Attia and others (this was not discussed in his interview w/Inigo) often misrepresent the zones with regard to actual measurement of lactate....

It took me two years to decide that competing in anything that resembled an endurance event was inappropriate for me. Likewise I decided I should not join my friends when they do long endurance activities. Rather than being highly technical about it, I just was trying to find a spot that allowed the admitted benefits of exercise without pushing me into the "too much" category. In a way, Maffetone's approach is simpler as it is based on heart rate. He has stated he is no longer a fan of lactate testing. If I were competing finding the "sweet spot" would be important. Since I don't compete now, I just want to do enough, but not too much. I also look at "minimum effective dose." I now do a lot of body weight exercise and suspension training. I use blood flow restriction training ("KAATSU") and also super (and sometime super super super) slow resistance training as a way to get the muscle growth stimulus with relatively low weights. My my avocations are rock climbing, skiing and hiking. I want to be in shape enough for that. For example, carrying a 50-70# climbing pack up a long, steep, rocky approach. I can do this.

I know I can ski the steeps all day off piste at high elevation (>12,000') without issue. However adding in hiking to each lap turns it into an endurance activity that can be a trigger. Likewise trying to see how many of these laps I can do in a day (skiing each lap as fast as possible) can also turn it into an endurance activity.

I know we are all different, however I seem to be able to do quite a bit of activity, whether it be climbing, skiing, suspension or other bodyweight training or even traditional cardio on a fan bike or fan rower if I limit my heart rate to Maffetone's suggested 180-age: 116 in my case. I'm not even anal about this and mostly don't wear a heart rate monitor, I just know what this level of effort feels like and limit it appropriately.

I have a friend who loves to skin up and ski down. That is not appropriate for me. I have a friend who will do century rides in the mountains, I also don't join him on those. My son wanted me to go to his CrossFit class. Again, not appropriate. What I've also learned about myself is that I do better on my own rather than something that will stimulate my competitive side. If that gets stimulated, then I'm more likely to ignore my subjective limits and push harder than is appropriate for me. I can ski with my friends or rock climb, but these are in no way competitions. One day I was skiing with my adult daughter. She lives 12 hours away, so these opportunities are rare. She is an excellent skier and I was pushing myself. Finally, I terminated my day an hour early as I felt if I pushed anymore, it would be a trigger. It was the right decision and I had no episode.