Hypothermia used to convert afib & flutter in an ancient paper.

In this 1959 paper, <[www.ncbi.nlm.nih.gov] hypothermia (cold) was used to convert some longstanding afib and flutter. One reason research like this is not done today is the standard of care will use rhythm meds that did not exist at the time.

There are protocols to convert adrenergic afib by creating a vagal response.

I am vagal and routinely take 20 minute baths in 49 deg F (9.5 C) water. When I started I would just immediately submerge myself in the water, up to my neck. This would commonly provoke what felt like runs of PAC's (a common precursor to afib for me). One day these PAC's were very "rowdy." I decided not to push my luck, even though they typically lasted for a few minutes and subsided. I started placing my face in the cold water for 20-30 seconds, then standing for 20-30 seconds, then sitting with water up to my navel for 2-3 minutes, then submerging up to my neck. This slower entry into the water did not stimulate these PAC's.

I'm guessing this would be most beneficial for those with an adrenergic (sympathetic) trigger. I know I have warded off some afib episodes by doing adrenergic activity when PAC runs strike (I'm very vagal).

I may try this the next time I go into afib, if I'm around cold water.

If you aren't cold adapted or experienced with cold, make sure you have someone around. You can go into hypothermia if not adapted. It can be serious or fatal. I've been playing with cold for a long time. For example, several weeks ago, I shoveled snow in 17 deg F weather wearing only shorts (no shoes, shirt, gloves or hat). Yes it did get cold on my feet and hands after an hour. Yesterday I rock climbed at 8,000' elevation wearing only shorts for 5 hours in 45 deg F air temp with 15-25 MPH winds. If you are not used to cold, be very careful.

George

George, are you a follower of Wim Hof? He is onto something as has been shown empirically.
I'm too comfortable (whimpy) to do the cold treatment.
[www.foundmyfitness.com]

Wow, George... good for you if you can stand that. It makes sense.
Glad you found it useful. I'm too timid but it's good to know.
Thanks for sharing and congrats on your successes!

Jackie

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Joe
George, are you a follower of Wim Hof? He is onto something as has been shown empirically.
I'm too comfortable (whimpy) to do the cold treatment.
[www.foundmyfitness.com]

Yes, Joe, I have his book. His approach is interesting. I look at cold as a gift to help maintain mitochondrial function. I recall as a youth never wearing a coat. I've also noticed that as most people age they get colder. The cold adapting I've done is starting to reverse this in me, at 62. I rock climbed on Saturday for 5 hours at 8,000' elevation in 42 deg F air temp with variable winds between 15 and 25 MPH wearing only shorts and a helmet. Other than for skiing, I don't recall when I last wore a coat. I now sleep with only a light sheet. Neurosurgeon, Jack Kruse, has written about cold thermogenesis and mitochondrial uncoupling extensively.

George

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Jackie
Wow, George... good for you if you can stand that. It makes sense.
Glad you found it useful. I'm too timid but it's good to know.
Thanks for sharing and congrats on your successes!

Jackie

Thanks Jackie. Have to adapt slowly. I think cold is a gift!

You inspire me, George!

The latest studies I am familiar with suggest that cold alone does not affect mitochondrial biogenesis. Rather exercise seems to be the main factor. Also, there is evidence that mitochondrial efficiency and not expression is actually more important in countering the effects of aging. And there is evidence that efficiency is improved with caloric restriction.

In my own case I only achieved remission from afib by significantly reducing my food intake along with fairly minor exercise moderation. Not supplements , special diets, or high intensity workouts (I haven't tried cold exposure yet). My body mass index is now low normal. Generally, my health is demonstrably better as well. Of course everyone is different. But I haven't seen much interest in caloric restriction in the afib setting or otherwise.

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safib
The latest studies I am familiar with suggest that cold alone does not affect mitochondrial biogenesis. Rather exercise seems to be the main factor. Also, there is evidence that mitochondrial efficiency and not expression is actually more important in countering the effects of aging. And there is evidence that efficiency is improved with caloric restriction.

In my own case I only achieved remission from afib by significantly reducing my food intake along with fairly minor exercise moderation. Not supplements , special diets, or high intensity workouts (I haven't tried cold exposure yet). My body mass index is now low normal. Generally, my health is demonstrably better as well. Of course everyone is different. But I haven't seen much interest in caloric restriction in the afib setting or otherwise.

None of this or the following (including cold or regular sauna which I've not talked about) has impacted my afib, which has been well controlled (with the exception of an ~18 month period when I stress ate wheels of brie during a divorce, increasing my calcium which diminished my afib control).

I did 19 five (one seven) day water fasts beseen May 2017 and January 2018 (pretty much a 120 hour fast every 14 days).. Hence about a 30% CR as I did not increase my food intake on feeding days. I've always remained fit, though for 12 years I've not trained for nor competed in endurance activities. One of my habits was to do a "super slow to failure" workout on day five of a fast, followed by a Tabata set (8x20:10 - 8 reps of 20 seconds as hard as possible followed by 10 seconds rest) on a fan (Concept 2) rower. One time my blood sugar was 31 mg/dL (1.7 mmol/L) while my serum ketones were 6.0 mmol/L. I managed to set significant PR's that day. Over the period, I managed to increase my time under load and load for all the strength exercises. The load on my leg press increased by 50%. My upper body strength increase was smaller as I was recovering from a double eject shoulder injury at 40 MPH two years ago, whjich I reinjured skiing 10 months later. In addition, I continue to do body weight exercises - for example, the original TRX Military Fitness Program (body weight & suspension straps) which is designed to prepare for Navy SEAL selection. Also normal "fun" activities like rock climbing and skiing the steeps off piste. All of my activities are fasted as I normally eat only once a day. The other day, after traveling and going to a hot spring, but having eaten the night before, my blood sugar was 61 mg/d: (3.4 mmol/L) and serum ketones were 2.7 mmol/L, so I'm fairly ketogenic, without trying (when I did a very detailed two week diet diary with a gram scale a year ago, my carbs averaged 85-180 g/day with a mean of 122, of which 50-60g/day were fiber). Having reasonable afib remission, I'm just trying for optimal health.

Your periodic and prolonged fasting coupled with "to failure" exercise seems like a very difficult and dangerous way to achieve caloric reduction. The numbers you quote for your blood sugar are dangerously low population-wise. Fasting is also associated with eating disorders. It seems like there are easier and safer ways than hypothermia and hypoglycemia to improve health and longevity. These conditions could negatively impact afib, whether vagal or adrenergic. I understand you are proud of your robustness, it is quite extraordinary. It will be interesting to see how long you can maintain this regimen, and what the long term consequences are. For safety and adherence, I prefer a gentler approach.

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safib
Your periodic and prolonged fasting coupled with "to failure" exercise seems like a very difficult and dangerous way to achieve caloric reduction. The numbers you quote for your blood sugar are dangerously low population-wise. Fasting is also associated with eating disorders. It seems like there are easier and safer ways than hypothermia and hypoglycemia to improve health and longevity. These conditions could negatively impact afib, whether vagal or adrenergic. I understand you are proud of your robustness, it is quite extraordinary. It will be interesting to see how long you can maintain this regimen, and what the long term consequences are. For safety and adherence, I prefer a gentler approach.

The "to failure" exercise expends almost no calories. That is not its purpose at all. The purpose of the hypothermia is also not caloric expenditure. I look at everything as signaling, not calories in/out. My weight is stable from 1 May 2017 to now. When doing the fasting, my weight is stable when looked at from the first day of a fasting cycle to the next. My BMI is about 24, so I am not a stick. I did a DXA scan last Sept and my body fat was in the 1st percentile for my age, for all limbs and my torso.

In 2005, the group at Mayo published a 30 year longitudinal study on afibbers in Olmstead County, MN (where the clinic is located). <[www.ncbi.nlm.nih.gov] Hans (the founder of the board) wrote about this. At the time, I chased down the full copy of the paper (which I don't have right now). What was striking to me is that the afbbers were healthier than the controls, however over time, they got metabolic illness like the rest of the population. I determined that I would do what I could not to follow this path. I purchased my first glucometer. This lead me on a path to becoming keto-adapted in 2009. Looking at Dr. Joseph Kraft's paper <[www.hippokrati.fi] (reprinted here by Meridian Valley), I determined I was likely hyperinsulinemic. Since ketone production does not exist in a hyperinsulinemic state, I decided that staying in mild ketosis (which I could sample via serum at home) was a decent proxy for remaining in a low insulin state. Catherine Crofts of Auckland NZ did her PhD thesis on Kraft's 15,000 samples of a 5 hour oral glucose tolerance test with insulin assay. It is here <[aut.researchgateway.ac.nz] She was trying to determine an easier test that would give similar results. She determined that an insulin sample two hours after ingesting the glucose would give nearly the same result, with under 30 being OK and above an indicator of hyperinsulinemia. She was at my house for dinner two weeks ago and I asked her if my approach was sound and she confirmed it is.

After I keto adapted (the process does carry risk of an afib episode if you don't monitor your electrolytes carefully), I learned I have a genetic risk for Alzheimer's Disease. This has, in my opinion, much higher stakes than afib, at least for me. In 2014, I started following Dr. Steven Gundry's approach to mitigating this risk (and for cardiovascular disease as well) and subsequently became a patient. I follow his advice for diet (and have posted on this elsewhere here). Every six months I consult with him. On my 6th set of labs in January, they were from 4 different laboratories and ran to 24 pages. They include many metrics on inflammation such as TNF-alpha, adiponectin, interleukins 6, 10, 17a as well as Tropoin I, oxidized LDL, omega 3 index, hormones & etc. My goal is to optimize these metrics and Gundry is very pleased with my results.

I have also met with Dr. Dale Bredesen 3 times. He is a long time Alz D researcher and author of The End of Alzheimers <[www.amazon.com]. I started incorporating his suggestions from his first paper in this light in 2014, when it was published.

As to fasting, I've met Toronto nephrologist, Dr. Jason Fung, who has successfully treated 5,000 patients with fasting in his clinic. I follow his general suggestions. I've also extensively reviewed the research of Dr. Valter Longo, of USC as well as the work of Dr. Guido Kroemer of University of Paris Descartes.

Likewise with my investigation of hypothermia on best practices.

I'm not suggesting that any of this will help someone's afib or that anyone follow my lead, especially without doing the background work that I've done to learn how to do all of this safely and what are best practices. While I don't believe any of this has made a difference in my afib, I've been very careful to do it in such a way that it does not negatively impact my afib remission. So far, this has been true. I don't know what optimum is or the best way to get there, but I am always surprised at what the body is capable of.

George

Well, I believe the hypothermia and especially hypoglycemia as you have described it are risky, and it isn't something that I would submit to for improving general health or aging-related issues, especially with my preexisting but latent afib. I am starting to look at your references and so far I see soft evidence for the claims that are made. I don't want to get into specific criticism of those claims, there is plenty of that on the web and it is easy to find. Even if these protocols and metrics were predictive, optimizing them in some kind of principled multi-objective and reproducible fashion is outside the realm of any practical exploratory analysis. I am skeptical what can be concluded, whether it generalizes to others, and so on. Actually, that doesn't bother me here, I understand the context of this discussion. The risk though distinguishes your approach. I am not sure how effectively one can mitigate that risk. Is doing a lot of reading and consultations and going slowly really enough?

I understand your goal was not caloric reduction, although it appears to have something in common with hypothermia and fasting, i.e., metabolic reduction. Indeed your 30% CR over 9 months from fasting was significant caloric reduction, whether it was your goal or not. Possibly the benefit derived (if any) was due to caloric reduction, and could be achieved without fasting. There is evidence that fasting is associated with eating disorders and other issues.

I see that there actually is a peer-reviewed literature on atrial fibrillation and caloric reduction, and also Alzheimer's and caloric reduction. Very recently there are some results which actually attempt to clarify risk/reward using hazard rates and survival analysis in order to make practically useful predictions from caloric reduction and polygenic Alzheimer's testing (not in the afib context though). So why not try caloric reduction without fasting? It seems simple and safe enough, although not as easy as popping a pill or a supplement, or trying some highly specialized diet, etc..

George - I certainly admire and respect your diligence in attacking the genetic risk with the ketogenic approach.
I listened to most of the Awakening from Alzheimer's webinar series a while back and found Dr. Bredesen's contributions more than 'impressive' ... as were many of the others. Just heard Dr. Fung talk on another topic. You have excellent resources. With your commitment and tenacity, I'm sure you will be successful. There are so many ailments that are responding with very positive results from a Ketogenic approach, it makes sense to pay attention.

Thanks for posting your details.

Jackie

Jackie (not George) - Actually caloric restriction and ketogenic diet are not mutually exclusive. Also, there are no peer-reviewed controlled trials that demonstrate ketogenic is effective at mitigating risk of Alzheimer's onset. It's all preliminary and speculative. Maybe I should cite CRYesKetoNO, and pronounce that the matter is settled. Sound familiar? But I don't care to engage in your kind of hyperbolic arguments and innuendo. So I will exit.

Peter



Edited 1 time(s). Last edit at 03/24/2018 09:34AM by safib.

safib,

I've I've said before, nothing I'm doing in this discussion has anything to do with my remission of afib. Nor am I trying to convince you or anyone else that what I do is without risk, or a good idea. I know that what I do has a complete lack of RCT's regarding efficacy (so did the successful afib remission program I concocted). I'm also well aware that Drs. Fung, Bredesen and Gundry have vehement critics.

As to fasting, on p 2760 <[www.jci.org] you'll see a graph where they fasted people for 50 days and then injected them with insulin. Their serum glucose dropped to 0.5 mmol/L (9 mg/dL) and yet they remained cognitively normal. Hence for someone who is making sufficient ketones, the cognition risk of hypoglycemia is minimal. This does not mean that someone who is unadapted does not have risk, they do (and especially those on diabetic meds). As I have posted about previously, keto adaptation carries risk for the afibber. This is because keto adaptation will drop serum insulin which will signal the kidney to excrete sodium and in severe cases potassium. This can initiate an afib episode. I do not recommend that afibbers try this unless they completely understand the risks and how to mitigate them with electrolyte supplementation (including and especially sodium).

Also with cold thermogenesis, the risk of hypothermia is real and can cause death. I don't recommend this without a spotter and knowing what you are doing. Exposing the body to a cold temperature can create risks for afib, too.. I've experience this on the 3rd day of a fast where a quick exposure to a 49 deg F bath led to PAC runs. I created a protocol where I expose my body to cold more slowly and the PAC's do not occur. Today, I skied 34,000' vertical at 12,000' elevation at 38 deg F and 20-25 MPH wind, naked on the upper body, also no sunscreen (I've posted elsewhere I no longer burn with a a serum 25OHD> 100ng/mL).. Not even the young bucks on spring break were doing this. I would not suggest this to you or anyone else. Just an observation of what proper training can accomplish.

My goal is to shrink the distance, in angstroms between cytochrome 1 and 5 on the inner mitochondrial membrane. This makes electron tunneling more efficient. This/ is the goal of cold thermogenesis as well as other non-standard approaches I've adopted. One place to start for more info are the publications of Dr. Douglas Wallace of Children's Hospital of Philadelphia on mitochondrial illness.

FWIW, i find your experience/experimenting very interesting! It doesn't mean i'll copy everything or anything you do.
Instinctively i feel that going into low keton keto metabolism for a short time (days or a few weeks) is beneficial on many levels.

Your feats need quite some training i suspect.

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Joe
FWIW, i find your experience/experimenting very interesting! It doesn't mean i'll copy everything or anything you do.
Instinctively i feel that going into low keton keto metabolism for a short time (days or a few weeks) is beneficial on many levels.

Your feats need quite some training i suspect.

Joe,

I'm firmly convinced that hyperinsulinemia is a root cause of many issues of aging. This may be true for many afibbers with comorbidities such as hypertension and CVD. It is less likely the case of afib for those (like me) who came to afib via chronic fitness. I noticed my trend toward hyperinsulinemia when I detrained due to afib.

If you decide to go low carb or keto, an excellent resource is Steve Phinney and Jeff Volek's book: <[www.amazon.com] Phinney is not a fan of fasting longer than a day or two, because of urinary nitrogen excretion data. At a conference a couple of weeks ago, I asked him if he thought that people who were well keto-adapted would start farther to the right (time on the X axis and urinary nitrogen excretion decreases over time as people adapt). He replied it was a good hypothesis but he had no data. This is not from Steve's data, but is an example of what is being discussed:

George

George, I used to do 4 to 5 day fasts a few times prior to afib. Since afib i've only fasted max. 30 to 40 hrs. It just didn't feel good to continue for longer.

Everything i've read re sugar and hyperinsulinemia agrees with your posts.

All I know is that being in the cold, breathing in cold air, can trigger afib for me, especially if I add a strenuous moment while in the cold. I know its not the same thing as a cold bath, but it would make me wary of trying it.
Nancy