Episode Transcript
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William Davis, MD (00:06):
Atrial
fibrillation, or AFib for short,
is the most common heart rhythmissue that plagues modern
people.
About 30% of people willexperience this rhythm disorder
at some time in their lives, anissue that becomes more and more
likely as we age.
The rhythm is typicallyexperienced as the sudden onset
of breathlessness andlightheadedness, and sometimes
(00:28):
chest pain, even while you'resitting or relaxing.
This is because, with AFib, theheart rate is typically in the
range of 150 to 220 beats perminute, way above the normal
resting heart rate of 60 to 70beats per minute.
It's the result of chaoticelectrical signals originating
from the atria of the heart, thenormally thin-walled sacs at
(00:51):
the top of the heart, on theright and left side, that is,
the right and left atria.
Beyond the symptoms ofbreathlessness and
lightheadedness, afib puts youat risk for stroke Not many
strokes, but large, catastrophicstrokes.
This is because there is apassive sac or appendage
attached to the side of the leftatrium, called the left atrial
(01:12):
appendage.
Because during a bout of AFib,the atria stop their normal
contractions in synchrony withthe powerful ventricles, the
main pumping chambers of theheart, blood stasis or
standstill occurs, allowing theformation of blood clots in the
left atrial appendage.
Should the blood clot, fragmentor dislodge, it can go to your
(01:33):
brain, resulting in acatastrophic stroke.
This is why, in conventionalcardiac care, blood thinners are
administered almost immediatelywith the onset of AFib.
The management of this abnormalheart rhythm is fraught with
difficulties and complications,toxic pharmaceuticals,
procedures such as DCcardioversion in which a large
(01:54):
and painful electrical shock isdelivered with paddles to your
chest and other strategies.
So it's a good idea to takesteps to avoid ever having this
abnormal heart rhythm.
Conventional advice typicallyincludes achieving such things
as controlling blood sugar andblood pressure with prescription
drugs or losing excess weight,but this leaves out some hugely
(02:15):
important strategies that youcan readily adopt that reduce
your potential for experiencingAFib, as well as numerous other
health conditions.
So that is the topic weconsider here in this episode of
the Defiant Health Podcast, andlater in the podcast let's talk
about Defiant Health's sponsorsPaleo Valley, our preferred
provider for many excellentorganic and grass-fed food
(02:37):
products, and BiotiQuest, mynumber one choice for probiotics
that are scientificallyformulated, unlike most of the
other commercial probioticproducts available today.
I'd also like to make you awareof a new source for our
favorite microbe of all,lactobacillus roteri, and a skin
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(02:58):
out.
So what exactly is atrialfibrillation?
So what exactly is atrialfibrillation?
Well, there are four chambersof the heart.
There are two atria, a rightatrium and a left atrium.
These are low-pressure sacsthat sit on the top of the heart
.
Then there are thehigher-pressure ventricles the
very high-pressure leftventricle that does most of the
(03:18):
work of pumping blood to therest of your body, and the
low-pressure right ventriclethat pumps to your lungs.
And these chambers contract insynchrony.
That is a specific order, sothat blood is pumped forward
into the lungs by the rightventricle, into the rest of the
body, out of the aorta on theleft ventricle side.
Now, this all occurs in a verypredictable fashion, but
(03:42):
sometimes something disturbs therhythm, the conduction and also
the rhythm generation.
So normal rhythm is generatedin a little piece of tissue
called the sinoatrial node inthe right atrium, and so when
you have a normal rhythm, wecall it sinus rhythm that comes
from the sinoatrial node.
Well, over the years, manypeople develop atrial fibrosis,
(04:06):
that is, replacement of atrialmuscle tissue with fibrous
tissue, which thereby allowschaotic generation and
conduction of rhythm, and that'swhen you have atrial
fibrillation.
Typical way of experiencingatrial fibrillation You're
sitting, minding your ownbusiness, watching TV or sitting
outside, just having a glass oficed tea or something, and you
(04:29):
feel your heart rate racingTypically 150, sometimes as fast
as 220 beats per minute, muchfaster than the usual 60 to 70
beats per minute.
Most people experience this asthe sudden onset of
breathlessness Severebreathlessness, can't catch your
breath, lightheadedness andsometimes chest pain, especially
if you have some measure ofcoronary disease, because that
(04:51):
rapid pumping prevents yourheart's arteries from filling
properly with blood and you canfeel chest pain.
So this is an emergency.
You need to go to the emergencyroom or an urgent care where
they can take steps to stop it.
You know I'm not a big fan ofthe medical system, as you know,
but there's a time and placewhen you do need these kinds of
things and then several thingshappen.
They put you in a bed, ofcourse, put an IV in and they
(05:14):
try to slow the heart rate down.
That's the first thing they do.
There's a series of drugs youcan give that, over hours, slows
the heart rate.
These are drugs like digoxinand beta blockers like
metoprolol and others, andcalcium blockers all meant to
slow the generation and theconduction of this excessively
rapid heartbeat, and that alonemakes you feel better when you
(05:34):
get your heart rate again below100 beats per minute.
They also anticoagulate you,because one of the problems, one
of the most catastrophicproblems that develops with
atrial fibrillation is when theatria are fibrillating, that is,
they're no longer contracting,they're quivering or not even
moving at all.
Well, there's an area on theleft atrium, so the rhythm is
(05:56):
generated in the right atrium,but there's an area on the left
atrium.
It's called the left atrialappendage.
It looks like a little ear onthe side of the left atrium and
when the right and left atriaare no longer contracting and
ejecting blood, there's bloodstasis and blood coagulates or
clots.
When it's static, when it's notmoving, and blood clots can
(06:18):
form in that left atrialappendage.
And those blood clots canfragment or dislodge and go to
your brain and these tend to belarge, catastrophic strokes.
You've probably heard of ministrokes.
Those often come from someplaceelse, typically the thoracic
aorta, atherosclerosis thatfragments in the thoracic aorta.
This kind of stroke that comesfrom the left atrial appendage
(06:41):
tend to be much larger becausethese clots are very large it
can be a centimeter in diameteror so and they go to the brain
and they cause catastrophicstrokes that are sometimes fatal
or sometimes involve majorincapacity, like losing the
capacity for speech or movementof the left side of the body or
other major impairments.
So you don't want a stroke fromatrial fibrillation.
(07:02):
So for that reason, most of thetime you're anticoagulated
right away with intravenousdrugs and then over time
switched over to oral drugs sothat the blood clot if a blood
clot had formed has time todissolve over several weeks to
months.
Now there's also drugsintroduced to try to convert the
rhythm back, to try to stopthis chaotic rhythm in the atria
(07:23):
and convert it back to a normalsinus rhythm.
These are unusual drugs youlikely never heard of, like
Sotolol and amiodarone and manyothers.
These tend to be very toxicdrugs but they're useful for
helping nudge the heart back ina normal sinus rhythm.
So you can imagine there's alot of moving parts here and
(07:43):
then, after all that is done,there's there's other issues
like should you be what's calledcardioverted, that is, a large
current passed through yourheart to break the rhythm and
restore normal rhythm.
There's also ablation, that is,the areas in the atria that are
responsible for generating thischaotic rhythm.
Usually several of them areessentially burned out.
(08:05):
They're mapped out and burnedout and that works most of the
time, not all the time.
And there's some otherprocedures, like they can put a
blocking device in your leftatrial appendage so that blood
clots can't form and that avoidsthe use or the need for
anticoagulants long-term.
Now, typically somebody goes tothe hospital for the first time,
has all these things introducedand then goes home, has to come
(08:27):
back for conversion of therhythm there are many variations
on this theme, but that'spretty much what they do and
then maybe you get normal rhythmback and then it comes back
three months later.
Go back to the hospital for afew days, they convert it again,
a few months later it comesback.
In other words, this is arevolving door.
In and out of the hospital isthe most typical experience Once
in a while.
(08:47):
Someone will have one bout andnever have another recurrence
for many years, but that'suncommon.
Much more common is to havemultiple recurrences over the
years.
A lot of aggravation, a lot ofmedications right Medications
for anticoagulation, medicationsto slow the heart rate during a
recurrence, medications toinhibit the return of the rhythm
, the antiarrhythmic agents andothers.
So you can imagine it's costly.
(09:08):
It's a real hassle, eats up alot of your time and energy.
It's going back and forth tothe hospital and to the doctor,
so it really pays to take stepsto not have atrial fibrillation.
So there's a number of discrete, identifiable ways that get you
to the atrial fibrosis thatallows.
Well, there are very commoncauses like high blood pressure,
(09:32):
and high blood glucose is areal powerful one.
Type 2 diabetics are much morelikely at least threefold more
likely to have atrialfibrillation.
Inflammatory phenomena, as oftencomes from people who have a
lot of abdominal fat, people whohave excessive abdominal fat.
That's a major source for bothinflammatory mediators and other
(09:54):
factors that cause atrialfibrosis.
Cigarette smoking, of course,but we know that no one should
be smoking cigarettes.
The point is, all those thingshigh blood glucose, type 2
diabetes, inflammation,excessive abdominal fat all
those factors are easilyaddressed.
Unfortunately, in conventionalcircles, what they do is give
you blood pressure medicationand blood sugar reducing
(10:17):
medication and anti-inflammatory, in other words, drugs that
introduce problems, oftensignificant problems of their
own.
So what we do instead isaddress the factors that allow
high blood pressure, high bloodglucose, inflammation to emerge.
So we take such steps asremoving the foods, wheat,
grains and sugars that causeweight gain, high blood glucose,
(10:39):
insulin resistance, etc.
Then we replace or restore thecommon nutrient deficiencies
that most modern people sharebecause of the way we live our
lives.
We don't get magnesium fromdrinking water because it's
filtered out.
We don't get vitamin D becausewe live our lives indoors, we
wear clothing outside, and welose the capacity to activate
vitamin D in the skin as we getolder, especially after age 40.
(11:02):
Many of us don't get iodinebecause we don't eat thyroid
glands of animals.
We can't get enough shellfishor seafood because of the
contamination with mercury andcadmium.
And then, lastly, omega-3 fattyacids.
Likewise, we can't eat all thefish we want because it's
contaminated with mercury.
We can't eat all the shellfishwe want it's contaminated with
(11:22):
cadmium.
So we'll replace those four andthose four things combined act
together synergistically tominimize insulin resistance, the
factor that drives high bloodsugar, diabetes, heart disease
risk, abdominal fat, andminimize inflammation.
So just those basic steps havetaken you many, many, many steps
closer to not having atrialfibrosis and thereby atrial
(11:45):
fibrillation.
Now another very importantfactor that leads to atrial
fibrosis that's becoming clearerand clearer with recent science
is the idea that dysbiosis inthe colon, or small intestinal
bacterial overgrowth we say SIBO, s-i-b-o in the small intestine
and thereby the endotoxemiathat results, are major drivers
(12:09):
of atrial fibrosis and therebyatrial fibrillation.
Let's pause for a moment totell you something about Defiant
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further of how dysbiosis, siboand endotoxemia can be major
drivers of atrial fibrosis andthereby atrial fibrillation.
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Now let's get back to ourdiscussion.
So think about that that atrialfibrillation, atrial fibrosis a
process in the heart, of coursecan get its start in the
gastrointestinal system,specifically an increase in
permeability of the intestinalwall and the entry of bacterial
(16:08):
breakdown products into thebloodstream, which is extremely
inflammatory.
So what causes the intestinesto be excessively permeable?
Well, there's a number ofthings unique to modern life
into the bloodstream, which isextremely inflammatory.
So what causes the intestinesto be excessively permeable?
Well, there's a number ofthings unique to modern life
Exposure to emulsifying agents.
These are agents such ascarrageenan, polysorbate 80,
carboxymethylcellulose andothers.
These are additives to food tomix them or to keep them mixed.
(16:31):
Things like peanut butter icecream is especially bad,
typically with three or fourdifferent emulsifying agents all
at once.
So take a look at yourprocessed foods.
You want foods that do notcontain these emulsifying agents
.
Good rule of thumb eat onlyfoods that don't have a label,
don't have an ingredient list,real foods like eggs or pork or
(16:53):
an avocado.
That way you know.
No one added something like anemulsifying agent.
The bowel prep of Miralax,typically used before a
colonoscopy, is a massivedisruptor of the intestinal
mucus barrier and thereby allowsunhealthy microbes to
proliferate, actually inflamethe intestinal wall and allow
the entry of breakdown productsfrom bacteria enter the
(17:15):
bloodstream.
So a very bad practice is touse Miralax as a prep for a
colonoscopy.
Should that happen, you shouldinsist on an alternative.
A very common alternative is touse magnesium in some form.
Magnesium preparations likemagnesium citrate are osmotic
agents.
They pull water into thegastrointestinal tract and it's
a very benign way.
Now, nobel prep is a pleasantprocess.
(17:36):
It is very unpleasant becauseyou have lots of diarrhea.
But an easy and benign way todo it is with magnesium.
You just have to use more thanthe usual dose to encourage that
osmotic effect, the entry ofwater into the gastrointestinal
tract, to clear it out of stoolsso the gastroenterologist can
see with his colonoscope.
Nonsteroidal anti-inflammatoryagents these are drugs like
(17:59):
ibuprofen and naproxen.
These are massive disruptors ofthe intestinal mucus barrier
and they cause ulceration in thesmall intestine and increase
intestinal permeability in thesmall intestine.
So that increases theintestinal permeability that
allows breakdown products entryinto the bloodstream.
Chlorinated drinking water is alikely disruptor of the
(18:19):
gastrointestinal lining becauseit dissolves the mucus barrier.
So we drink only filtered wateror other sources of water that
are not chlorinated or, evenworse, chloraminated that is
made sterile with the use ofchloramine rather than chlorine.
Chlorine is relativelyshort-lived, chloramine is
relatively long-lived.
You can't even boil it off.
It takes a minimum of threedays of boiling to even start to
(18:40):
remove the chloramine isrelatively long-lived.
You can't even boil it off.
It takes a minimum of threedays of boiling to even start to
remove the chloramine.
So we drink.
We filter our drinking water.
The gliadin protein of wheat isa massive cause of increased
intestinal permeability.
You may recall that theoriginal research that
identified gliadin as a factorthat increases intestinal
permeability came from DrAlessio Fasano's work while he
(19:03):
was at University of Maryland,now at Harvard, and he was
looking to find another factorthat causes an increase in
intestinal permeability and hewanted to find something that
mimicked the effects of choleratoxin.
So if you've ever seen cholera,it's a horrible, horrible
disease.
This often happens in thirdworld countries or where there's
war and fecal contamination ofdrinking water and people
(19:26):
develop incessant, endlessdiarrhea so bad they often cut a
hole in the gurney so thatdiarrhea can pour out into a pan
because they can't keep up withthe diarrhea and most people
die of dehydration.
They can't keep up with thefluid needs of the incessant
diarrhea.
Well, cholera toxin causes that.
It causes unrestricted entry ofwater into the intestines.
(19:49):
Well, the gliadin protein wasthe only thing he could find
that mimicked the effect ofcholera toxin, except it didn't
allow water to enter theintestines.
It allowed other things likebreakdown products of food or
bacteria to enter the intestines.
It allowed other things likebreakdown products of food or
bacteria to enter thebloodstream and lymph.
That, by the way, was alsofound to be by Dr Fasano's work
and his team to be theinitiating factor in many, if
(20:12):
not most, forms of autoimmunediseases, because entry of those
foreign products fools yourimmune response into attacking
organs that resemble thoseforeign factors.
But the real problem in the vastmajority of people.
So those things you can fixright.
You can try to avoid having abowel prep with Miralax.
You can avoid processed foodsthat have emulsifying agents in
them and choose whole foodsinstead.
(20:33):
You can avoid the use ofnon-steroidal agents.
You can filter your drinkingwater, so all relatively easy to
remedy and all those thingshelp you reduce or minimize
abnormal intestinal permeability.
And, of course, going wheat andgrain-free to avoid the gliadin
protein and the relatedproteins of other grains such as
the secalin and rye, thehordean and barley, the zean and
(20:55):
corn are also provokers ofincreased intestinal
permeability.
But a real common cause, and avery potent cause of increased
intestinal permeability andthereby entry of breakdown
products of bacteria into thebloodstream is the overgrowth of
fecal microbes, so-calledgram-negative enteric or fecal
microbes.
(21:15):
This is a situation where,because of our exposure to
antibiotics and other factors,fecal microbes have been allowed
to over-proliferate in thecolon and then ascend into the
24 feet of small intestine.
And the small intestine issimply not equipped to deal with
trillions of fecal microbes,because the small intestine is
supposed to have a very lowcount of bacteria and is meant
(21:38):
to be very permeable becausethat's where we absorb most
amino acids, fatty acids,vitamins and minerals.
So the small intestine is meantto be very permeable.
But when the small intestine isinfested by trillions of fecal
microbes that live and die inshort order, they only live for
a few hours.
When they die, they shed theircomponents, only live for a few
(22:02):
hours.
When they die they shed theircomponents, especially a
component of their cell wallcalled endotoxin.
And that endotoxin is able toenter the lymph and the
bloodstream through thepermeable small intestine.
And when that happens, whenendotoxin occurs at high levels
in the bloodstream, that'scalled endotoxemia.
Endotoxemia is a situationwhere there's 200 to 400%
increase in the level of thisendotoxin.
(22:22):
That's probably a markedunderestimation because the
method used to measureendotoxemia only only identifies
some of the forms of endotoxin.
That is, the endotoxin ofdifferent species may differ and
are not all identified by themethod used.
So, for instance, the endotoxinof E coli may differ from the
(22:43):
endotoxin of citrobactercampylobacter or pseudomonas.
And so, except that any measureof endotoxemia in studies it's
not available clinically, it'sonly something used in clinical
studies underestimates thedegree of endotoxemia.
So endotoxemia is likely muchworse than it appears.
But it's that increaseintestinal permeability caused
(23:03):
by the overgrowth of those fecalmicrobes or proteobacteria in
the small intestine that allowsthe entry of endotoxin
endotoxemia into the bloodstream.
That is a major driver ofatrial fibrosis and atrial
fibrillation.
So it's my view this work hasto be extended further, but it's
my view that SIBO and therebyendotoxemia, is going to prove
(23:27):
to be the major driver of atrialfibrillation and that your
efforts to prevent atrialfibrosis and thereby
fibrillation are incomplete Ifall you do is just good things
and diet and vitamin D andomega-3 fatty acids and iodine
all the basic things we do.
You've taken several stepsforward in reducing your
potential for atrialfibrillation, but your efforts
(23:49):
are not complete unless youaddress bowel flora.
Now recall that we do so in myprograms by doing several things
.
We make sure we consume lots offermented foods.
These are foods like sauerkrautthat are fermented naturally,
not sauerkraut and brine Kimchivegetables you ferment on your
kitchen counter.
Kefir, real yogurts, not thestuff in the grocery store.
(24:12):
Those are you want to includeevery day, several times per day
.
Curiously, they provide specieslike Leuconostoc mesenteroides
and Pediococcus pentasatius.
These are microbes that don'ttake up residence in the GI
tract.
So what good are they?
Well, something happens whenyou consume these fermented
foods with those non-colonizingmicrobes.
As they pass through, theysomehow provoke the
(24:36):
proliferation of beneficialmicrobes that do take up
residence.
These are very beneficialmicrobes like Fecalobacterium
and Acromantia and RuminicAcacia Don't remember those
names, but those are veryimportant species that do many
good things.
They support the proliferationof other beneficial microbes.
They produce beneficialmetabolites such as butyric acid
that mediates many of thewonderful effects of fermented
(24:59):
foods and microbes likereduction of blood sugar and
blood pressure and better sleep.
So plenty of fermented foods,very important.
We re-implant keystone species,the two most important,
lactobacillus rhoderi andLactobacillus gasseri, and the
reason for that is these are twomicrobes that are very unique
(25:20):
in that while most microbesprobiotic type species, colonize
the colon, these two are knownto uniquely colonize the small
intestine where SIBO occurs,where they're known to produce
bacteriocins, naturalantibiotics effective in killing
those invading fecal microbes.
(25:41):
So we make a yogurt.
It doesn't have to be dairy, itcould be something else, but
yogurt's the easiest.
We make yogurt out of those twospecies and we consume half cup
per day, typically for fourweeks at the start and then
intermittently, maybe threetimes a week, something like
that, chronically, because weyet don't know how to make these
things colonize the intestinepermanently.
(26:03):
So we rely on ongoingconsumption to restore and
maintain those microbes and thishas been far more effective
than I ever expected.
So far, of over about 50 peoplewho've done this, 90% have
tested negative for hydrogen gason the breath.
That's how we test for SIBO, sothat combination can be called
(26:23):
SIBO yogurt.
See my recipes in the Super Gutbook for SIBO yogurt.
In that recipe I also addedbacillus coagulans.
That's optional.
I'm not sure how much that adds, but you have the option of
adding bacillus coagulans.
But at the very least you wantto do lactobacillus roteri and
certainly at the beginninglactobacillus gasseri.
Long-term you have a choiceeither roteri alone or roteri
(26:45):
gasseri, both in combination.
Long-term, what you're doing isre-implanting those species to
inhibit the colonization, theinfestation of your 24 feet of
small intestine with fecalmicrobes.
Then we make sure we includelots of fibers and other related
compounds.
These are things.
These are the fibers fromlegumes or other root vegetables
(27:06):
, inulin powder that you can buy, galacto-oligosaccharides from
black beans, white beans, hummus, chickpeas so see the list in
my Super Gut book.
Also, all throughout my blog,my drdavisinfinitehealthcom blog
or williamdavismdcom blog,you'll see lists of prebiotic
fibers and related compounds allthe foods that you can consume
(27:27):
that feed microbes and make themproliferate the beneficial
microbes.
So, I believe, is my predictionthat management of colonic
dysbiosis, but even more so,small intestinal bacterial
overgrowth and the increasedintestinal permeability and
endotoxemia, management of theseissues will prove to be one of
(27:47):
the most important revelations,one of the most revolutionary
approaches to inhibiting, toreducing the likelihood of
developing atrial fibrosis andthereby atrial fibrillation.
Now, if you've learnedsomething from this episode of
the Defiant Health Podcast, Iinvite you to subscribe to your
favorite podcast directory.
Post a review, post a comment.
(28:07):
Help us grow this movement ofself-empowerment and health and
freedom from the clutches of thehealthcare system.
Thanks for listening.