Red Palm Oil Lowers Cholesterol

Red Palm Oil Lowers Cholesterol




Red Palm Oil Removes Arterial Plaque, Lowers Cholesterol and Fights Cancer



Palm oil, particularly virgin or “red” palm oil, is a traditional fat that has been a part of the human diet for at least 5000 years. For generations red palm oil has been revered as both a nutritious food and a valuable medicine. It was prized by the pharaohs of ancient Egypt as a sacred food. The oil was so highly valued that it was entombed with the pharaohs so that they would have access to it in the afterlife.


Palm oil comes from the fruit of the oil palm (Elaesis guineensis).Originating in tropical Africa, it has now spread throughout much of world. Today it is an important crop in Southeast Asia, West Africa, and South America.



Throughout history palm oil has served as the primary source of dietary fat for countless numbers of people. Its nutritional and healing properties have been recognized for generations. Until modern medicine arrived, red palm oil was the remedy of choice for nearly every illness in many parts of Africa. When someone was sick, downing a cup full of palm oil was common. Even today many people in the villages rely on this age old method of treatment. Palm oil is regarded among many as essential in the diet for pregnant and nursing women in order to assure good health for the mother and child.



Palm Oil Treats and Prevents Malnutrition


Today, medical doctors are recognizing the value of red palm oil in the treatment and prevention of malnutrition and vitamin deficiency diseases. Governments around the world are incorporating it into programs to wipe out deficiency diseases which are still rampant in many impoverished areas.

Red palm oil not only supplies fatty acids essential for proper growth and development, but it is packed with an assortment of vitamins, antioxidants, and other phytonutrients important for good health. Red palm oil gets its name from its characteristic dark red color. The color comes from carotenes such as beta-carotene and lycopene—the same nutrients that give tomatoes and carrots and other fruits and vegetables their rich red and orange colors.

Carotenes are valuable nutrients and powerful antioxidants. They are also important because our body can convert them into vitamin A, an essential nutrient. Vitamin A deficiency can cause blindness, weaken bones, lower immunity, and adversely affect learning ability and mental function. Vitamin A is only found in animal foods. Such foods, are too expensive for many people. Carotenes in fruits and vegetables can supply the needed vitamin A if an adequate amount of fat is also consumed. Carotenes require fat for conversion into vitamin A. Unfortunately, those who can’t afford animal products often do not eat much fat either. Populations with ample carotene-rich foods available often suffer from vitamin A deficiency because they don’t get enough fat in their diet.

Red palm oil provides a perfect solution. It supplies the needed fat and vitamin A precursors. Red palm oil is the richest dietary source of provitamin A carotenes (beta-carotene and alpha-carotene). It has 15 times more provitamin A carotenes than carrots and 300 times more than tomatoes. This has made it a valued resource in the treatment of vitamin A deficiency. Just one teaspoon a day of red palm oil supplies children with the daily recommend amount of vitamin A. Nursing mothers are encouraged to supplement their diet with palm oil to enrich their milk with the vitamin. Studies show that adding red palm oil into the diet can double or triple the amount of vitamin A in mother’s milk.

The children are not only getting the vitamin A they need but other important nutrients as well. Red palm oil is a virtual powerhouse of nutrition. It contains by far, more nutrients than any other dietary oil. In addition to beta-carotene, alpha-carotene, and lycopene it contains at least 20 other carotenes along with vitamin E, vitamin K, CoQ10, squalene, phytosterols, flavonoids, phenolic acids, and glycolipids. Palm oil is one of the richest natural sources of vitamin E. In addition to ordinary vitamin E, it also contains the highest amount of a super potent form of vitamin E known as tocotrienol. There are four tocotrienols. Palm oil contains all of them. These tocotrienols have up to 60 times the antioxidant activity of ordinary vitamin E. The combination of vitamin E, tocotrienols, carotenes, and other antioxidants makes palm oil a super antioxidant food.

Red palm oil is loaded with so many nutrients and antioxidants it’s like a natural dietary supplement. In fact, it is currently being encapsulated and sold as a vitamin supplement. The oil is also available in bottles like other vegetable oils for kitchen use.

In government programs for the treatment of nutritional deficiencies, palm oil is simply incorporated into the food. It’s easy for a child to get a teaspoon of red palm oil when it is used to cook vegetables or bread. Palm oil is an excellent for cooking and baking. It consists of 50 percent saturated fatty acids, 40 percent monounsaturated fatty acids, and 10 percent polyunsaturated fatty acids. The high saturated and monounsaturated fatty acid content makes palm oil a very heat resistant and stable oil. It has a high smoke point of 437 degrees F. The high saturated fat and antioxidant content makes it extremely resistant to oxidation and free-radical formation.



Red Palm Oil and Cardiovascular Health


Over the past two decades researchers have painstakingly studied palm oil’s effect on cardiovascular health. The results have been surprising to researchers. Although high in saturated fat, it protects against heart disease.

Studies show that adding palm oil into the diet can remove plaque build up in arteries and therefore, reverse the process of atherosclerosis. This has been demonstrated in both animal and human studies.

In one study, for instance, 50 subjects were divided into two equal groups. All the participants had been diagnosed with atherosclerosis and had suffered at least one stroke. At the beginning of the study the degree of blockage of their carotid arteries ranged from 15 to 79 percent.

Without any other changes to their diets or medications, half of the subjects began taking a daily palm oil supplement. The other half received placebos and served as the control. The degree of atherosclerosis was monitored using ultrasound scans over an 18 month period. In the group receiving red palm oil, atherosclerosis was halted in 23 of the 25 subjects. In seven of these subjects atherosclerosis was not only stopped but regressed. In comparison, none of those in the control group showed any improvement, in fact, the condition in 10 of them worsened (Tomeo, 1995). This study demonstrated that red palm oil can not only stop, but even reverse atherosclerosis.




Red Palm Oil Lowers Cholesterol


Removing plaque is not the only way palm oil protects against strokes and heart attacks. Palm oil can also improve cholesterol values. In a study at the University of Illinois College of Medicine, researchers demonstrated a 10 percent decrease in total cholesterol in 36 hypercholesterolemic (high cholesterol) subjects given palm oil capsules for four weeks. A follow-up study of 16 subjects resulted in a 13 percent lowering of total cholesterol (Qureshi, 1995).

In another study 31 subjects took a red palm oil supplement every day for 30 days. No other changes were made to their diets. They continued to eat whatever they desired. The results showed that palm oil supplementation lowered both total cholesterol and LDL (bad) cholesterol in all the volunteers. The magnitude of reduction of total cholesterol ranged from 5 to 35.9 percent and the reduction of LDL cholesterol ranged from 0.9 to 37 percent. What was even more important was the effect the palm oil had on the cholesterol ratio. The cholesterol ratio was reduced in 78 percent of the subjects, demonstrating a highly significant and favorable response to supplementation (Tan, 1991).



Red Palm Oil Maintains Proper Blood Pressure


Palm oil helps maintain proper blood pressure. The high antioxidant content of the oil quenches free radicals and keeps inflammation under control. In one study researchers induced inflammation in the arteries of test animals. Inflammation causes swelling which narrows artery passageways, restricting blood flow to vital organs such as the heart. Half of the animals received palm oil in their diet while the other half served as the control. In the control group artery passageways were severely constricted and 42 percent of the animals died. However, those that received the red palm oil showed far less inflammation and constriction resulting in a 100 percent survival rate.



Red Palm Oil Strengthens the Heart


Tocotrienols also strengthen the heart so that it can better withstand stress. Researchers can purposely induce heart attacks in lab animals by cutting off blood flow to the heart. This causes severe injury and death. However, if the animals are fed palm oil the survival rate is greatly increased, injury is minimized, and recovery quicker (Esterhuyse, 2005).

After looking at studies like this it becomes obvious that palm oil protects against heart disease. This is confirmed in populations where palm oil consumption is particularly high. Heart disease in Malaysia, Indonesia, Papua New Guinea, and Nigeria—where palm oil is a major if not the sole source of visible fat in the daily diet—are among the lowest in the world (Sron, 2005).



Red Palm Oil Protects Against Cancer


The high antioxidant content of red palm oil makes it a potent anticancer food. Palm tocotrienols are especially benefical in this respect. Antioxidants have long been known to offer protection against various forms of cancer. Tocotrienols being highly potent antioxidants have demonstrated remarkable anticancer properties far superior to most other antioxidants.

Studies show palm tocotrienols inhibit the growth of skin, stomach, pancreas, liver, lung, colon, prostate, breast and other cancers. Most of the research to date has been done with breast cancer where tocotrienols show great promise. They not only prevent cancer from taking hold but actively block its growth and initiate apoptosis—a process where diseased cells commit suicide. This is a normal process that is programmed into all of our cells in order to remove old and diseased cells. However, in cancer cells this process is blocked and affected cells continue to multiply and grow without restraint. Ordinary vitamin E, does not induce programmed cell death in cancer cells. Only tocotrienols have this effect.

Initial research has been so impressive that cancer researchers have called tocotrienols the most powerful natural anticancer substances known to science (Yano, 2005). That’s quit a bold statement, but illustrates the potential tocotrienols have in cancer prevention and treatment.



Red Palm Oil Protects the Brain


The antioxidant power of red palm oil has also shown to be of benefit in protecting against neurological degeneration. Two of the most significant factors that affect brain function are oxidative stress and poor circulation. Oxidative stress generates free radicals that damage brain and nerve tissue. Poor circulation affects the brain by restricting oxygen and glucose which are vital for proper brain function. Researchers have found correlations between oxidative stress and reduced blood flow to the brain to senile dementia, Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and even schizophrenia. All of these conditions involve brain cell death. Tocotrienols aid the brain by reducing oxidative stress and improving blood flow.

Researchers can mimic much of the destruction seen in the above neurological disorders by feeding test animals glutamate—an amino acid that kills brain cells. The primary action of cell death is caused by free radicals. Ordinary vitamin E is not strong enough to prevent glutamate-induced cell death. But palm tocotrienols can quench the destructive action of glutamate. In laboratory studies tocotrienol-treated neurons maintain healthy growth and motility even in the presences of excess glutamate (Khanna, 2003).



Adding Red Palm Oil to Your Diet is Easy


Research is showing that the antioxidant power of red palm oil can be of help in protecting against a variety of health problems including osteoporosis, asthma, cataract, macular degeneration, arthritis, and liver disease. It can even stunt the processes that promote premature aging. It’s no wonder it was regarded as a sacred food by the ancient Egyptians.

Red palm oil is not just for pharaohs, it’s available to everyone. It is sold as a cooking oil and as a dietary supplement at most good health food stores and online.

For more information about the health aspects of red palm oil read The Palm Oil Miracle by Dr. Bruce Fife, ND. 




Esterhuyse, A.J., et al. Dietary red palm oil supplementation protects against the consequences of global ischemia in the isolated perfused rat heart. Asia Pac J Clin Nutr 2005;14:340-347.

Khanna, S. et al. Molecular basis of vitamin E action: tocotrienol modulates 12-lipoxygenase, a key moderator of glutamate-induced neurodegeneration. J Biol Chem 2003;278:43508-43515.

Qureshi, A.A., et al. Response of Hypercholesterolemic subjects to administration of tocotrienols. Lipids 1995;30:1171-1177.

Sron, B. Palm oil’s track record. Global Oil and Fats 2005;2:24-25.

Tan, D.T.S., et al. Effect of a palm-oil-vitamin E concentrate on the serum and lipoprotein lipids in humans. Am J Clin Nutr 1991;53Suppl:1027S-1030S.

Tomeo, A.C., et al. Antioxidant effects of tocotrienols in patients with hyperlipidemia and carotid stenosis. Lipids 1995;30:1179-1183.

Yano, Y., et al. Induction of cytotoxicity in human lung adenocarcinoma cells by 6-0-carboxypropyl-alpha-tocotrienol, a redox-silent derivative of alpha-tocotrienol. Int J Cancer 2005;115:839-846.






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Managing High Blood Pressure in Seniors

Managing High Blood Pressure in Seniors



A reading of 130/80 mmHg or higher constitutes high blood pressure (HBP), also known as hypertension. Nearly half of all American adults has high blood pressure, and once it develops, it usually lasts a lifetime.

 High blood pressure is called the silent killer because it usually presents with no noticeable symptoms. Some people may not find out they have it until they begin experiencing problems with their heart, brain or kidneys. The good news is that keeping track of blood pressure, taking medication and lifestyle changes can help lower blood pressure and keep it under control.


What is Blood Pressure?


Blood pressure is the force of the blood pushing against the walls of the arteries as it circulates throughout the body. This pressure is highest when the heart beats, pumping the blood. This is called systolic pressure. When the heart is at rest between beats, blood pressure falls. This is known as the diastolic pressure.

Blood pressure is always given in the form of two numbers, one over the other, like a fraction. The systolic pressure is the upper number, and the diastolic pressure is the lower number. Both of these measurements are important. For example, a person’s BP reading may be 120/80 mmHg. Millimeters of mercury (mmHg) is the unit used to measure pressure. For this reading, you would read the blood pressure as “120 over 80.”



What is Normal Blood Pressure in Seniors?


Blood pressure naturally fluctuates throughout the day, but it is lowest when you are sleeping. It can also rise when you are excited, nervous or active. For most waking hours, though, BP stays relatively stable and should be lower than 120/80 mmHg.

In general, lower numbers are better, but very low BP can also be a cause for concern. Consistent readings in the elevated or prehypertension range increase the likelihood that hypertension will develop unless preventative actions are taken. Individuals of any age who have chronic kidney disease and/or diabetes should pay close attention to their BP.


Classifications Systolic Pressure   Diastolic Pressure
Normal Less than 120 and Less than 80
Elevated 120-129 and Less than 80
Stage 1 Hypertension 130-139 or 80-89
Stage 2 Hypertension 140 or higher or 90 or higher
Hypertensive Crisis (call 911) Higher than 180 and/or Higher than 120


The guidelines above are for the general population, but seniors’ health needs and benchmarks differ from those of younger individuals in many ways. While 130/80 mmHg is the generic threshold for beginning BP medications, there have been many disagreements among medical professionals regarding the threshold for older adults. Age, frailty and other comorbidities like diabetes and chronic kidney disease complicate this matter even further.

The Eighth Joint National Committee (JNC 8) issued guidelines in 2013 recommending that individuals over age 60 aim for a reading below 150/90 mmHg. The JNC 8 recommendation for patients of any age with diabetes or chronic kidney disease is to aim for BP readings below 140/90 mmHg. These are not hard and fast rules, though, because each senior’s health needs are unique.

“The JNC 8 guidelines support what we geriatricians have believed for quite some time: many older adults are taking too much BP medication,” says Dr. Leslie Kernisan, M.D., M.P.H. In addition to increasing an elder’s prescription drug costs and compounding the potential for a medication mishap, unnecessary BP medications can cause risky side effects in seniors. Orthostatic hypotension, or a temporary drop in BP upon standing, is one of the riskiest side effects since it can cause dizziness and contribute to falls.

“We do want to treat high BP, because it reduces the chance that an individual will have a stroke or experience heart problems,” Dr. Kernisan acknowledges. “However, clinical studies have shown that treating high BP is most beneficial when it helps people get their systolic BP (the top number) down around 150. In geriatrics, the goal is to balance the likely benefits of a medication with the likely burdens and risks. The goal of 150 may seem high, but treating to a target of less than 150/90 brings on increased risks but usually doesn’t offer additional benefits.”

Discuss any concerns you may have about a senior’s BP with their physician, or better yet, a geriatrician who specializes in treating older patients. They will be able to weigh the pros and cons of beginning or adjusting treatment and possibly suggest alternative measures for trying to get their numbers under control.



What Causes High Blood Pressure?


BP rises naturally as we age. In many seniors with high blood pressure, a single specific cause is not known. This is called essential or primary high blood pressure. Research is ongoing to find the causes of essential HBP.

In some people, high blood pressure is the result of another medical problem or medication. When the direct cause is known, this is called secondary high blood pressure.


Who is at Risk?

Men over age 45 and women over age 55 who are overweight or have a family history of HBP are at the highest risk of developing elevated BP.

A number of lifestyle factors can raise blood pressure as well. These include:


  • Eating too much salt;
  • Drinking too much alcohol;
  • Not getting enough potassium in your diet;
  • Not doing enough physical activity;
  • Taking certain medicines;
  • Exposure to long-term stress; and
  • Smoking.



Complications of High Blood Pressure


High blood pressure causes the heart to work harder, therefore arteries take a beating, and the chances of stroke, heart attack, and kidney problems are greater.

When high blood pressure is left undiagnosed and untreated, it can cause:


  • Enlargement of the heart (which may lead to heart failure).
  • Small bulges (aneurysms) in blood vessels. Common locations are the main artery from the heart (aorta), arteries in the brain, legs, and intestines, and the artery leading to the spleen.
  • Blood vessels in the kidneys to narrow, which may cause kidney failure.
  • Hardening of the arteries, especially those in the heart, brain, kidneys and legs. This can lead to a heart attack, stroke, kidney failure or amputation of part of the leg.
  • Blood vessels in the eyes to burst or bleed, which may cause vision changes and can result in blindness.



Taking Blood Pressure Measurements


People can have HBP for years without knowing it. Along with checking other vital signs, taking a BP measurement with a blood pressure cuff and stethoscope or an electronic sensor is common practice at the beginning of most medical appointments.

If a patient’s readings are high, most doctors will recheck their blood pressure several times on different days before making a treatment determination. A diagnosis is given if repeated readings are elevated.

Measurements should be taken when a patient is relaxed and sitting upright with both feet flat on the floor.

Caregivers can use these tips to help ensure their loved ones receive accurate readings:


  • Do not let the senior drink coffee or smoke cigarettes 30 minutes before BP measurements are taken.
  • Remind them to wear short sleeves.
  • Encourage the senior to use the restroom beforehand.
  • Allow them to sit and rest for 5 minutes before the test.

Some people’s blood pressure is elevated only when they visit the doctor’s office. This condition is called white coat hypertension and occurs when patients experience even minor anxiety in clinical settings. If the doctor suspects this, you may be asked to check and record your elder’s blood pressure at home, using a home device or an ambulatory blood pressure monitor (ABPM). This ABPM is worn for 24 hours and can take reliable blood pressure readings approximately every 30 minutes.

If you must check your loved one’s blood pressure at home, it is important that you work with the doctor to choose an approved device and understand how to use it properly. BP monitors can be bought online, at durable medical equipment (DME) stores and pharmacies, but they are typically not covered by Medicare.


Example: OMRON BP742N 5 Series


How is High Blood Pressure Treated in the Elderly?


Some people can prevent or control high blood pressure by embracing healthier habits and making lifestyle changes. The following objectives can help seniors reduce their BP:


  • Following a heart-healthy diet, which includes cutting down on salt intake and increasing consumption of fruits, vegetable, and low-fat dairy products;
  • Losing excess weight and maintaining a healthy weight;
  • Engaging in regular physical activity;
  • Quitting smoking; and
  • Limiting alcohol intake.


Sometimes blood pressure remains elevated, even when a person makes healthy changes. In that case, it is necessary to add medication to help lower BP. Medicines will control the condition and help prevent further complications, but they cannot cure it.


Medications for High Blood Pressure


There are a number of pharmaceutical options for treating hypertension, and each one works in a different way to lower blood pressure. Often, a combination of two or more medicines work better than one.

Medications commonly prescribed for the treatment of HBP include:


  • Diuretics are often called “water pills.” They work by helping the kidneys flush excess water and salt from the body. This reduces the amount of fluid in the blood, thereby lowering blood pressure. A diuretic is often used in conjunction with another type of medicine, and this treatment option may be available in a single combined pill.


  • Beta-blockers help the heart beat slower and with less force. The heart pumps less blood through the blood vessels, and pressure decreases.


  • Angiotensin-converting enzyme (ACE) inhibitors keep the body from making a hormone called angiotensin, which causes blood vessels to narrow and elevates BP. ACE inhibitors prevent this narrowing and reduce stress on the heart.


  • Angiotensin II receptor blockers (ARBs) are a newer type of medicine. Instead of preventing the formation of angiotensin (like ACE inhibitors), ARBs block the hormone from working in the body. ARBs are usually prescribed for patients who do not tolerate ACE inhibitors well.


  • Calcium channel blockers (CCBs) prevent calcium from entering the muscle cells of the heart and blood vessels, causing the vessels to relax and blood pressure to decrease.


  • Alpha-blockers relax muscles in the blood vessel walls, allowing blood to pass more easily and causing blood pressure to go down.


  • Alpha-beta blockers combine the effects of alpha- and beta-blockers described above.


Suggested Reading: Blood Pressure Down

by Janet Bond Brill, Ph D., R.D., LDN

In Blood Pressure Down, Janet Bond Brill distills what she’s learned over decades of helping her patients lower their blood pressure into a ten-step lifestyle plan that’s manageable for anyone. You’ll: 

   • harness the power of blood pressure power foods
   • start a simple regimen of exercise and stress reduction
   • stay on track with checklists, meal plans, and more than fifty simple recipes

Easy, effective, safe—and delicious—Blood Pressure Down is the encouraging resource that empowers you, or your loved ones, to lower your blood pressure and live a longer, heart-healthy life.  Read reviews on Amazon.

Final Thoughts

It is important for caregivers to ensure seniors monitor their blood pressure and take their  medication(s).   Make sure medications are taken at the same time each day and do not skip doses or cut pills in half to save money. If you have any questions or concerns about your loved one’s condition or medications, do not hesitate to speak with their doctor.


Thanks for visiting and reading … I hope this article provided some helpful ideas.  I welcome your comments below.







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Managing Atrial Fibrillation


Managing Atrial Fibrillation





When the heart is in its normal rhythm, the atria contract at steady, regular intervals. But in AF, the atria’s electrical signals occur much more rapidly, often 350 to 500 times per minute. At these rates, the muscle just can’t contract in a coordinated fashion.

Instead of producing an atrial beat, the muscles just quiver (fibrillate) ineffectively. The ventricles are bombarded by fast, irregularly spaced atrial impulses, but they are partially protected from breakneck speed by the AV node, which intercepts the atrial impulses and blocks many of them before conducting some to the ventricles. Still, the ventricular rate is usually much faster than normal, and the rhythm is irregular, as is your pulse.


The human heart is divided into four pumping chambers (see figure). The two upper chambers are called the atria; they collect blood from the veins, then pump it into the two ventricles, larger and stronger chambers that propel the blood out from the heart to the rest of the body.

To function best, the atria should contract first, with the ventricles close behind. The electrical messages that signal the heart muscle to contract begin in the atria (at the SA node), and then travel across the AV node into the ventricles to trigger the contractions you feel as your pulse. The entire sequence can be recorded on an electrocardiogram (ECG), where the atrial contractions appear as P waves and the ventricular contractions that follow show up as QRS complexes.


AF: Up close and personal

illustration of heart in normal rhythm and ECG reading


In normal sinus rhythm, the sinus node initiates the electrical activity that triggers each heartbeat. The electrical impulse travels through the atria, signaling the muscle to contract; each atrial contraction shows on the ECG as a p wave. The electrical activity then crosses into the ventricles, stimulating them to contract and pump blood to the body’s tissues (shown in ECG as the QRS complex).


illustration of heart in atrial fibrillation and ECG showing irregular pattern


In atrial fibrillation, the atria’s electrical signals are very rapid and erratic; the atria don’t contract and there is no p wave. Without a coordinated signal to guide them, the ventricles contract at a rapid rate in an irregular rhythm.


AF Is Becoming More Common


AF is an old problem, but it’s becoming more common. At present, between 2.3 million and 5.1 million Americans are affected, and 150,000 new cases are diagnosed each year. The consequences are enormous, including almost 400,000 hospital admissions, 5 million office visits, and health care costs of over $6.5 billion a year. Even worse, AF increases the risk of stroke fivefold and almost doubles the risk of premature death. But there is good news, too: treatment can help.



Causes of AF


Scientists don’t fully understand the basic problems behind AF, but they do know many of the factors that increase the risk of AF.


Age is an important factor; AF is uncommon before age 50, but it affects nearly 8% of men between 65 and 74 and almost 12% between 75 and 84.


Gender is also important; AF occurs about 50% more frequently in men than women. Since about a third of all patients with AF have a family history of the disorder, heredity also plays a role, and several specific genetic abnormalities have already been identified.


Cardiovascular conditions are strongly linked to AF. The three most important are high blood pressure, heart valve disorders (particularly mitral valve problems), and coronary artery disease (with or without a heart attack). Heart failure, a debilitating problem that occurs when the weakened heart muscle is unable to pump blood effectively, is another risk factor for AF. Less often, inflammation in the membrane around the heart (pericarditis) triggers AF.


Lung disorders also increase the risk of AF. Culprits include chronic obstructive lung disease, blood clots in the lungs (pulmonary emboli), and pneumonia. Chest surgery is another cause.


A wide variety of medical conditions are associated with AF. An overactive thyroid gland (hyperthyroidism) is the best known; it’s what sent President George H.W. Bush into AF (and into the Bethesda Naval Hospital) in 1991, and even high-normal thyroid activity predisposes one to AF. Diabetes and obesity increase risk, as do medications such as bronchodilators used for asthma and COPD, decongestants, steroids, and nonsteroidal anti-inflammatory drugs.


Behavioral factors are also tied to AF. Always a villain, smoking is on the hit list. Moderate drinking does not lead to AF, but excessive alcohol consumption does, particularly in the setting of binge drinking. Anger and hostility boost the risk of AF in men. Surprisingly, perhaps, caffeine does not appear to be a risk factor.

Although vigorous exercise sometimes triggers AF in young men, walking and other moderate physical activities provide long-term protection. Some studies suggest that taking statin drugs or eating fish may reduce the risk of AF over the long run, while others do not. Beta blockers, ACE inhibitors, and angiotensin-receptor blockers (ARBs) appear to reduce the risk of AF in patients with hypertension.





There are several ways to categorize AF. In one system, it’s called primary AF when the problem originates in the heart itself, and secondary AF when it results from a noncardiac medical condition, in which case the AF often resolves when the underlying problem is corrected. When primary AF occurs in a structurally normal heart, it is called lone AF, which carries a relatively low risk of complications. Other types of primary AF, however, can be more troublesome.

Another classification system for AF depends on the frequency and duration of the arrhythmia:

  • paroxysmal AF — recurrent episodes of AF that end within seven days without treatment. Most bouts of paroxysmal AF end in less than 24 hours, but even though episodes are brief, patients are still at risk of stroke.
  • persistent AF — episodes that last longer than seven days or require treatment to convert back to a normal heart rhythm. The longer an episode lasts, the harder it is to restore a normal rhythm.
  • permanent AF — AF that has lasted longer than a year.






The symptoms of AF vary widely. They tend to be more severe in older people and in those who also have structural heart or lung disease. Men who are in good general health may not even be aware of the arrhythmia. Others notice a fluttering sensation in the chest or a rapid and/or irregular heartbeat. Fatigue, increased nighttime urination, shortness of breath, and exercise intolerance are common and can be severe in patients who had weakened hearts or diseased lungs even before AF hit.

Lightheadedness, confusion, and sometimes even fainting may signal a substantial fall in blood pressure due to AF. Patients with coronary artery disease may suffer angina or a heart attack when they develop AF. Because AF reduces the heart’s pumping capacity, fluid can build up in the legs or lungs, particularly if the patient had some degree of heart failure even before the onset of AF.





Doctors suspect AF when they hear an irregular heartbeat or feel an irregular pulse; a standard electrocardiogram, or ECG, will confirm the diagnosis if the patient is tested during an episode of AF. But if the AF is paroxysmal, or intermittent, a doctor may ask his patient to wear a Holter monitor or event monitor at home; these are small devices that record ECG tracings continuously (Holter) or intermittently (event) to document brief or episodic arrhythmias.







Diagnosing AF is relatively easy, but testing doesn’t stop there. In most cases, doctors will order an echocardiogram or cardiac ultrasound to evaluate the heart’s valves and muscular contractions; an advanced type of ultrasound, the transesophageal echocardiogram, may be used to evaluate stroke risk. Blood tests to measure thyroid, kidney, and liver function and red blood cell levels are important. Many patients benefit from additional lung or heart studies.




The Risks of AF


Heart Failure

AF reduces the heart’s pumping capacity. Although the atria are small chambers with relatively weak muscles, they still contribute a “kick” or boost to the larger, more powerful ventricles. In addition, the rapid heart rate of AF reduces the efficiency of each beat. In all, AF reduces the heart’s pumping capacity by 10% to 30%. People whose hearts are otherwise healthy can compensate for this impairment, but those with damaged heart muscles or valves cannot. As a result, they experience the fatigue, breathlessness, exercise intolerance, and swelling of the feet and legs that are so characteristic of heart failure. AF can also trigger the chest pain of angina or a heart attack in patients with coronary artery disease.



The other major complication of AF is stroke. Although doctors have studied AF for over 100 years, the risk of stroke was not fully appreciated until the 1980s, when the Framingham Heart Study reported that 24% of its stroke patients were also in AF, and that the abnormal heart rhythm developed within the six months preceding the stroke in about a third of these participants. AF quintuples the risk of stroke. It accounts for about 15% of all strokes and for nearly a quarter of all strokes in people ages 80 to 89.

How does a cardiac abnormality cause brain damage? Since fibrillating atria don’t contract, they contain relatively stagnant pools of blood. Clots (thrombi) form in these areas, then break off and travel to the brain, where they block small arteries, depriving the brain of its vital oxygen and causing tissue damage and death. It’s a devastating sequence of events, but it can be prevented by anticoagulants, medications that fight blood clots. In fact, the use of anticoagulants is one of the key priorities in the management of patients with AF. The others are slowing the heart rate and, in some patients, restoring a normal heart rhythm.



Rhythm or Rate?


Since the dangerous complications of AF result from its abnormal rhythm, logic dictates that restoring a normal rhythm would be the highest priority of therapy. Cardiologists understand that logic, but they also know that clinical trials are necessary to find out if theory translates into reality.

Between 2000 and 2008, six independent, high-quality clinical trials randomly assigned patients with AF to one of two treatment groups. In one group, the goal of therapy was to control the heart rate while tolerating the irregular rhythm; in the other, the goal was to restore and maintain a normal rhythm when possible. A similar, very high percentage of patients in both groups received the recommended anticoagulant therapy to prevent strokes.

A total of 6,615 patients volunteered for the six trials. Despite differences in the patient groups and the methods used to achieve rate or rhythm control, all the trials arrived at the same conclusion: rhythm control does not produce better results than rate control in terms of survival, cardiac complications, or relief of symptoms. In fact, the rhythm control strategy was associated with a higher rate of hospitalizations and greater expense.

Why did rhythm control morph from no-brainer to no benefit? Restoring and maintaining normal rhythm is no small feat. It typically involves medications and may require additional procedures ranging from an electric shock to heart surgery. Slowing a racing heart requires medications, too, but they are safer and produce fewer side effects than the specialized drugs used for rhythm control. And since most AF patients require anticlotting medication even after normal rhythm is restored, the rhythm control strategy does not even have the advantage of reducing the burden of anticoagulation.

These important randomized clinical trials suggest that rate control may be the first choice for many, even most, patients with AF. Still, some may benefit from rhythm control. Likely candidates include individuals who are diagnosed promptly after the onset of AF, patients with a first episode of AF, patients with AF triggered by a medical problem that has been corrected, younger people, and those who continue to have troublesome symptoms despite rate control. And if these considerations are not complex enough, there are several ways to slow rapid AF and many, many options for rhythm control.


  • Recommended: Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD


Slowing a Rapid Heart Rate


Medication can slow down the racing heartbeat in nearly all patients with AF. The most useful drugs are beta blockers (such as propranolol and metoprolol) and calcium-channel blockers (such as diltiazem and verapamil); even so, digoxin (the modern version of the foxglove plant first used for AF over 225 years ago) still has a role in select patients. Some patients with an abnormal electrical pathway in their hearts (the WPW syndrome) respond to amiodarone.

Patients who have chest pain or shortness of breath can receive rate-controlling medications intravenously; most respond in minutes to hours. Oral medications take longer to kick in, but most patients with sustained AF require long-term oral medications to maintain heart rate control.

Although precise heart rate targets have not been established, many doctors adjust medications to achieve a heart rate of about 60 to 80 beats per minute when the patient is at rest and about 90 to 115 during moderate exercise. However, a study found that lenient heart rate control with a target resting rate of up to 110 beats per minute is just as beneficial as stricter target heart rates.

The fastest and most effective way to convert AF back to a normal heart rhythm is to jolt the heart with an electric shock. Electrical cardioversion sounds shocking, even drastic, but since it uses only a small, brief pulse of DC current, it is really quite safe — and since patients are sedated, it’s only mildly uncomfortable.

Electrical cardioversion is most likely to succeed when used soon after the onset of AF.

To prevent stroke, nearly all patients who have been in AF for more than 48 hours should have three to four weeks of anticoagulation (see below) prior to cardioversion, and nearly all benefit from at least four weeks of anticoagulation after the procedure. Anticoagulation should be continued indefinitely in patients at moderate to high risk of stroke, even if they maintain a normal rhythm.


Drugs can also be used to convert patients from AF to a normal rhythm, and long-term medication may be needed to preserve a normal rhythm after successful electrical or pharmacological cardioversion; long-term anticoagulation is also generally necessary.

The choice of medication is tricky, and anti-arrhythmic medications can have severe side effects, even including serious arrhythmias. As a result, while primary care physicians often manage rate control, rhythm control is best guided by cardiologists. Amiodarone is frequently the drug of choice. Dronedarone is a similar but more expensive medication; although it once appeared safer, serious side effects have been reported. Other specialized drugs that may be useful include sotalol, flecainide, and propafenone. Some carefully selected patients with recurrent bouts of AF can take a single dose of flecainide or propafenone on their own (the “pill-in-the-pocket” approach) to convert AF as soon as they notice the irregular heartbeat of AF.

Cardiologists don’t give up easily, and they have developed a new treatment for patients who do not respond to electrical or pharmacologic cardioversion and continue to have symptoms from AF despite rate control. The idea is to destroy a tiny amount of tissue in or near the heart to stop it from sending out the abnormal electrical signals that trigger AF. First, patients undergo sophisticated testing to detect and map the offending tissue. Next, doctors thread a tiny catheter, or tube, through a blood vessel in the groin up into the heart. When the tip of the catheter is up against the offending tissue, which is usually in or near the pulmonary veins, a radiofrequency electrical current is passed through the catheter to destroy, or ablate, the target.



Radiofrequency Ablation


Radiofrequency ablation is a relatively new and tricky procedure that is only available at specialized cardiac centers.



In radiofrequency ablation, catheters are placed intravenously and advanced to several positions within the right heart. These catheters can be used, as with the EP Study, to record from and stimulate the heart. These catheters can be manipulated throughout the heart in an attempt to identify the precise location from which an arrhythmia originates. Since most arrhythmias require a specific and usually small area of the heart in order to begin or continue, localization of these key, but ablating these vulnerable sites, could lead to elimination of the arrhythmia.

If these sites are identified, a catheter is moved to this area of the heart. The tip of a specially designed catheter placed in this position can be used to deliver high frequency, or radiofrequency, energy. This energy will heat up the adjacent tissue to the point of coagulation. The amount of tissue heated, however, is quite small. But if it includes the critical area for arrhythmia formation, this tissue can be permanently made nonfunctional and thus incapable of causing an arrhythmia.

The anticipated results of the procedure depend somewhat on the nature of the arrhythmia targeted. For the most common arrhythmias, the procedural success rate by experienced operators is in the range of 90-99%. The risks of the procedure are generally small and often only related to intravenous puncture. Serious cardiac complications are uncommon, but can occur.

The procedure:  the catheters used for the ablation will be inserted through the veins in the groin. Usually, two to three catheters are inserted into a vein on the right side of the groin. The patient won’t feel the catheters moving through the blood vessels and into your heart. These catheters will be positioned in your heart using a special type of x-ray called fluoroscopy (live-action picture).

Controlled impulses will then be delivered through one of the catheters to induce the suspected abnormal heart rhythm. The electrophysiologist may decide to use sophisticated computer aided 3 Dimensional mapping system and intracardiac echocardiography to identify the arrhythmia circuit and its source.

Once the arrhythmia source is identified and located, the RF energy will be delivered for 30 to 90 seconds at a time through one of the catheters to the abnormal pathway. Sometimes it”s necessary to deliver the energy several times to ablate (eliminate) the pathway. When it appears the abnormal pathway has been ablated, the physician will test to be certain your abnormal heart rhythm can no longer be triggered.

Throughout the entire procedure, the patient’s ECG, heart rate, blood pressure, and oxygen level will be constantly observed on monitors in the laboratory. Although an ablation is usually not painful, one may experience some discomfort from lying still for a long time.



Short-term results have been promising, but relapses of AF mount over the years; more research is needed. And doctors continue to develop additional treatments for patients who need more help; examples include approaches that involve pacemakers and even surgery (the Cox maze and “mini-maze” operations).

These developments offer help to the relatively small number of patients who need cutting-edge therapy. But for most patients with AF, the most important step of all is to use simple anti-clotting medications to prevent stroke.



Preventing Stroke


Most patients with AF feel fine once their heart rate is controlled. But their well-being is deceptive, since they are still at risk for stroke. The risk is particularly high in older patients, in patients with hypertension, and especially in patients with previous strokes or heart valve disease, particularly an artificial valve or narrowing of the mitral valve (mitral stenosis).

Fortunately, anticoagulants (“blood thinners”) can help protect AF patients from stroke. These choices are currently the most common:


Aspirin is the simplest, safest, and least expensive, but it is also the least effective, reducing the risk of stroke by about 20%.  The best aspirin dose has not been determined, but most doctors recommend 81 to 325 milligrams (mg) a day. The dose of warfarin should be adjusted to maintain an INR (international normalized ratio) result of 2.0 to 3.0. The standard dose of dabigatran is 150 mg twice a day.


Warfarin (Coumadin) reduces the risk of stroke by about 60%. It has been the mainstay of therapy for decades, but it requires careful attention to medications and dietary factors that affect therapy as well as frequent adjustments in dose, based on the results of blood tests performed every two or three weeks.


Dabigatran (Pradaxa) , a major new option, was approved for use in the U.S. in October 2010. Dabigatran is at least as effective and safe as warfarin, and it does not require the dietary restrictions and frequent blood tests that make warfarin therapy tricky and inconvenient. On the downside, dabigatran therapy requires two pills a day, and because it is new, long-term results are not known. Dabigatran is also much more expensive than warfarin and, unlike warfarin (which can be reversed by vitamin K), there is no way to rapidly counter its anticoagulant effect. Patients with severe liver or kidney disease, recent strokes, or artificial or severely diseased heart valves should not use dabigatran.


Rivaroxaban (Xarelto) is similar to dabigatran; it has already been approved in the U.S. to prevent blood clots after hip and knee surgery, and, based on successful trials, is up for FDA approval to prevent strokes due to AF. Apixaban (Eliquis) is an even newer member of the same drug class. It has been approved in Europe, and a major 2011 American trial reported that it was safer and better than warfarin for preventing strokes in patients with AF.


Which program is best for a patient with AF? The so-called CHADS2 score can help estimate the risk of stroke and guide the choice.


Risk factor Points
Age 75 or above 1
Diabetes 1
Heart failure 1
Hypertension 1
Previous stroke or transient ischemic attack (TIA, or “mini-stroke”) 2

Patients with a CHADS2 score of 0 do not need anticoagulants; those with a score of 1 may take aspirin, warfarin, or dabigatran (or rivaroxaban or apixaban once approved); and those with a score of 2 or higher should take warfarin or dabigatran (or rivaroxaban or apixaban), as should patients with AF and mitral stenosis or artificial heart valves.



Researchers are working hard to improve the management of AF. But for now, the tried and true will serve most patients well: slow the racing heart, consider restoring normal rhythm if symptoms persist, and reduce the risk of stroke by preventing clots.

Atrial fibrillation is an old problem, but it can be treated effectively, whether by standard therapy or new innovations.





Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD

Many patients suffering from Atrial Fibrillation have three strikes against them:




1. Their “quality of life” has deteriorated; they are scared or frightened.

2. Many experience side effects from the common drug therapies or simply do not want to live on medication; a cure for their A-Fib hasn’t been discussed.
3. Patient information is often out-of-date, incomplete or biased toward a specific pharmaceutical or treatment; much information about new treatment options is written in the language of scientists and doctors.


The author, Dr. Steve Ryan, PhD, a former A-Fib patient, addresses all these issues. His book is written for the newly diagnosed patient and any A-Fib patient who doesn’t want to wade through medical texts and research journals to understand their disease.  Read the reviews.


Beat Your A-Fib helps patients and their families look beyond the commonly prescribed drug therapies that only manage the disease, but do not cure it.


Beat Your A-Fib: The Essential Guide to Finding Your Cure offers:


  • Unbiased, up-to-date information and best practices
  • Medical terms and concepts translated into everyday language
  • Non-drug treatment options including Cardioversion, RF catheter ablation, Pulmonary Vein Isolation, CryoBalloon, Cox-Maze and Mini-Maze surgeries, and AV Node Ablation with Pacemaker
  • Research-based content with a bibliography of over 150 medical references
  • ‘Lessons learned’ from A-Fib patients now enjoying lives free of the burden of A-Fib
  •  Recommended Resources and Website Links
  • Patient tools to become their own best healthcare advocate


This unique book helps patients research their best treatment options, steps through how to find the right doctor for their type of A-Fib and treatment goals, gives patients hope and empowers them to develop a plan for finding their A-Fib cure or best outcome.

Dr. Walter Kerwin, MD, of Cedars-Sinai Medical Center Los Angeles, California, wrote the Foreword for the book. Dr. Steven C. Hao, MD, of California Pacific Medical Center, San Francisco, California, penned the Introduction.

Dr. Steve Ryan, PhD, is a noted healthcare educator and advocate for patients with Atrial Fibrillation, and former A-Fib patient. He earned his Ph.D. in Educational Communications from the Ohio State University.

Read the reviews.


You may also be interested in:

Lifestyle Tips for Warfarin Users

Warfarin Alternatives for Those With Atrial Fibrillation

The Most Powerful Herb on the Planet

Living With Angina From Coronary Artery Disease

The Fat Loss Diet I Recommend

About Me

Create Your Own Blog



Warfarin Alternatives For Those With Atrial Fibrillation

Warfarin Alternatives For Those With Atrial Fibrillation



New Alternatives to Coumadin (warfarin) to Reduce the Risk of Stroke in the Treatment of Atrial Fibrillation Provide Doctors and Their Patients with More Options.


Atrial fibrillation is a heart rhythm disturbance that affects up to 3% of the adult population but is found more frequently as people age. It interferes with the orderly contraction of the atria or upper chambers of the heart. When the atria fibrillate, blood stagnates and clots can form and sail in the blood stream from the heart to arteries in the brain, blocking them and causing a stroke.

In patients with atrial fibrillation, the older someone is or the more abnormal heart function is, the higher the risk of clots forming is. Thus methods to thin the blood can reduce the risk of stroke. 

In patients less than 65 years of age with no diabetes, high blood pressure, history of stroke or significant structural heart disease, often aspirin alone suffices. However, most patients with atrial fibrillation do require more than just aspirin and that is where anticoagulants are needed to reduce the risk of stroke.

Of course, under normal circumstances, blood clotting is a good thing, because it stops bleeding if we are injured. However, clotting in the heart is a bad thing as it can lead to a stroke. Thus achieving the right balance of the risk of stroke versus serious bleeding is the goal.



Coumadin (Warfarin)


The widely used anticoagulant, or “blood thinner” Coumadin (warfarin) has been the long-term standard treatment to prevent clots from forming in the left atrium. Warfarin works by reducing the body’s ability to make vitamin K, which interferes with the liver’s ability to make blood-clotting proteins. As you might guess, thinning the blood can increase the risk of patients’ tendency to bleed and warfarin requires frequent monitoring to ensure that patients are getting the proper dose.

The goal with Coumadin is to administer it in doses strong enough to inhibit clots from forming in the atrium but not too strong to cause dangerous bleeding. The therapeutic window (blood thin enough not to clot in the atrium and not too thin to cause harm) is small and can vary widely from one patient to the next. Newer genetic tests promised to be helpful in predicting what dose a patient might need but have not turned out to be practically useful in day-to-day practice.

The effect of Coumadin is measured by a blood test called the protime or INR (international normalized ratio). Patients receiving Coumadin must have the INR test regularly (usually once a month or so once they are otherwise on a stable dose). Depending on the INR, we adjust the Coumadin dose. Many different medications and foods can interfere with Coumadin’s effect.  Some patients have been on Coumadin for many years with no significant changes in their dosage and no significant bleeding problems. Some patients have to come in to the office very frequently to have their dosage changed or monitored.

An online resource from the American Heart Association can help patients receiving warfarin as their anticoagulation. “A Patient’s Guide to Warfarin,” which describes how the anticoagulant works, drugs that interact with it, adverse effects to watch for, and the importance of wearing a medical alert bracelet. It also offers an easy-to-understand explanation of several anticoagulation concepts, such as prothrombin time and the International Normalized Ratio, and provides a list of patient do’s and don’ts.



Having alternatives to warfarin provides doctors and their patients with more options especially in those who have found it hard to keep their INR stable and/or needing frequent dosing adjustments.



Pradaxa (dabigatran)



The FDA approved Pradaxa (dabigatran) in the fall of 2010 for the prevention of stroke from atrial fibrillation. Pradaxa interferes with the functioning of already formed clotting proteins (direct thrombin inhibitor). The net effect is the same as Coumadin.

In one trial, Pradaxa, at the highest dose, was found to be slightly more effective than Coumadin in preventing stroke caused by atrial fibrillation in a very select group of patients. The overall bleeding risk was similar but the risk of serious bleeding in the brain was slightly lower with the higher dose of Pradaxa while there was more bleeding from the gastrointestinal tract with Pradaxa compared to warfarin. At the lower dose of Pradaxa, the risk of stroke was similar with slightly less overall bleeding rates.

Pradaxa has been used in Canada since 2008 to prevent leg clots after knee replacement surgery. Pradaxa does not require blood testing but has to be taken twice a day while Coumadin is taken once a day.



Xarelto  (rivaroxaban)


The FDA approved Xarelto (rivaroxaban) at a low dose in July 2011 to help prevent deep vein thrombosis (DVT, clots in the leg veins that can travel to the lung and be life threatening) after knee or hip replacement surgery. Then in the fall 2011 it was approved at a higher dose to reduce the risk of stroke from atrial fibrillation.

In one trial, Xarelto showed similar efficacy compared to warfarin in preventing stroke with similar overall bleeding risk in patients with atrial fibrillation (slightly less frequency of serious bleeding in the brain and slightly more bleeding from the stomach and intestines). Xarelto interferes with the functioning of already formed clotting proteins (factor Xa inhibitor). Xarelto does not require blood testing and is taken once daily similar to Coumadin.



Eliquis (apixaban)


Approved by the FDA (December 2012) after a study showed very promising results of this factor Xa inhibitor’s ability to reduce the risk of stroke from atrial fibrillation with lower overall risk of bleeding compared to warfarin. In addition, the overall risk of significant complications or death appears to be lower with Eliquis than with warfarin and is the first of the new anticoagulants to show this.

It has to be taken twice daily (with or without food) but always at the same dose while Coumadin (warfarin) is taken once daily (usually in the evening) but dosing can vary depending on blood test results. Eliquis does not require blood testing. Eliquis has also been approved by the FDA to prevent deep vein thrombosis (DVT) or pulmonary embolism (PE) after hip or knee surgery and to treat DVT and PE.



Savaysa (edoxaban)



The fourth new oral anticoagulant was relatively recently approved by the FDA (January 2015). Edoxaban is the third factor Xa inhibitor approved by the FDA to reduce the risk of cardioembolic stroke in patients with atrial fibrillation after a study showed very promising results of this factor Xa inhibitor’s ability to reduce the risk of stroke from atrial fibrillation with lower overall risk of bleeding compared to warfarin.

Interestingly, patients with the most normal kidney function appear to not benefit as much with edoxaban although it might be a reasonable option for those with impaired kidney function. Savaysa is taken once daily.



Coumadin Vs. The New (Alternative) Oral Anticoagulants


Coumadin (warfarin) has been used for preventing strokes in patients with atrial fibrillation, patients with mechanical heart valves and treating patients with clots in the leg veins (deep venous thrombosis or DVT) or that have travelled to the lungs (pulmonary embolism) for over six decades. Thus, for cardiologists or doctors who have used it for many years, we know what to expect and are quite experienced with it.

Warfarin is an effective, time-tested anticoagulant option for most patients, especially in the setting of minimal food-drug interactions, reliable monitoring and good patient compliance. Having said that,  it can be a challenge for some patients in achieving a stable dose and avoiding interactions with other medications or certain foods.

Pradaxa, Xarelto, Eliquis and Savaysa do not appear to require dosage adjustments based on what type of diet one eats or (with rare exception) other medications one takes (as opposed to warfarin which often needs to have dosage readjustments due to dietary or medication changes). However, unlike warfarin, Pradaxa, Xarelto and Eliquis all need dosage adjustments in patients with abnormal kidney function and Pradaxa and Xarelto essentially cannot be used in those with severe kidney disease (those who are on dialysis).

If one has life threatening bleeding while their blood is thinned out on warfarin, there are antidotes that can be given to reverse the blood thinning effects and allow the blood to clot better. There are no known antidotes to reverse the effects of Pradaxa, Xarelto, Eliquis or Savaysa.  However, all of these medications have relatively short half-lives which means that their effects wear off fairly quickly and often the patient could be supported until the blood thinning effects wear off.

While there is theoretical concern about not being able to reverse their effects, studies comparing these new agents with warfarin do not show an overall increase in life-threatening bleeding and a similar overall safety profile.

The disadvantage of the newer blood thinners’ effect wearing off quicker is that if a patient inadvertently misses a dose, the risk of clots forming goes up fairly quickly until the next scheduled dose is taken.

For the appropriate patient, the new oral anticoagulants are able to overcome some of the shortcomings of warfarin, such as its slow onset of action, variable therapeutic effects, food-drug interactions and the need for close monitoring. At the same time, the new oral anticoagulants are limited by their high cost, lack of specific antidotes, and lack of long-term safety data.

Patients with prosthetic heart valves should not take Pradaxa, Xarelto, Eliquis  or Savaysa nor should patients with atrial fibrillation that is caused by a heart valve problem. These patients have not been studied in clinical trials with Xarelto, Elliquis or Savaysa and in a study with Pradaxa, patients with mechanical heart valves had higher rates of clots forming and, interestingly, bleeding as well.

Coumadin costs approximately $50 – $100 per month (depending on how many pills used to achieve appropriate dosing) and generic warfarin $14 – $50 per month but the cost might be even lower when filled through a prescription plan.  However, if one factors in the costs of having to have lab work done routinely and more frequent doctor or nurses visits, the monthly costs are clearly higher although it is difficult to give an exact additional price. Pradaxa, Xarelto and Eliquis are all around $250 – $300 per month and are not as frequently covered by prescription plans as generic warfarin. When they are covered, they usually require a higher co-pay. There are no generic forms of Pradaxa, Xarelto or Elquis available at this time, nor will there be generic options for them for many years.


Implantable Devices



In the spring of 2015, the FDA approved the Watchman left atrial appendage closure device as an alternative to warfarin for patients with nonvalvular atrial fibrillation.

Some patients have a high risk of being on anticoagulants or have difficulty tolerating them. The vast majority of clots that form in patients with atrial fibrillation occur in a small out-pouching of the left atrium called the left atrial appendage. A device that closes off or occludes this appendage from the rest of the left atrium can be implanted by an interventional cardiologist via a non-surgical procedure. However it is still an invasive procedure with some risk.

In addition, patients for whom this procedure is considered, still have to take warfarin for at least 6 weeks after the procedure is performed until adequate healing within the heart occurs. They then have to usually be on aspirin and clopidogrel (Plavix) for a while longer and then aspirin indefinitely thereafter. Long-term outcomes are still unclear but it does appears to be a promising alternative and certainly can be appropriate for a select number of patients.


Many other factors in an individual need to be considered and would include that if someone has been on Coumadin for a long time with minimal or no significant problems or side effects, if might be prudent to “leave well enough alone” (“if it ain’t broke, don’t fix it”). In addition, there perhaps are slightly more gastrointestinal side effects with Pradaxa (and Xarelto) compared to Coumadin.



Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD

Many patients suffering from Atrial Fibrillation have three strikes against them:

1. Their “quality of life” has deteriorated; they are scared or frightened.

2. Many experience side effects from the common drug therapies or simply do not want to live on medication; a cure for their A-Fib hasn’t been discussed.

3. Patient information is often out-of-date, incomplete or biased toward a specific pharmaceutical or treatment; much information about new treatment options is written in the language of scientists and doctors.

The author, Dr. Steve Ryan, PhD, a former A-Fib patient, addresses all these issues. His book is written for the newly diagnosed patient and any A-Fib patient who doesn’t want to wade through medical texts and research journals to understand their disease.


Beat Your A-Fib helps patients and their families look beyond the commonly prescribed drug therapies that only manage the disease, but do not cure it.


Beat Your A-Fib: The Essential Guide to Finding Your Cure offers:

  • Unbiased, up-to-date information and best practices
  • Medical terms and concepts translated into everyday language
  • Non-drug treatment options including Cardioversion, RF catheter ablation, Pulmonary Vein Isolation, CryoBalloon, Cox-Maze and Mini-Maze surgeries, and AV Node Ablation with Pacemaker
  • Research-based content with a bibliography of over 150 medical references
  • ‘Lessons learned’ from A-Fib patients now enjoying lives free of the burden of A-Fib
  •  Recommended Resources and Website Links
  • Patient tools to become their own best healthcare advocate

This unique book helps patients research their best treatment options, steps through how to find the right doctor for their type of A-Fib and treatment goals, gives patients hope and empowers them to develop a plan for finding their A-Fib cure or best outcome.

Dr. Walter Kerwin, MD, of Cedars-Sinai Medical Center Los Angeles, California, wrote the Foreword for the book. Dr. Steven C. Hao, MD, of California Pacific Medical Center, San Francisco, California, penned the Introduction.

Dr. Steve Ryan, PhD, is a noted healthcare educator and advocate for patients with Atrial Fibrillation, and former A-Fib patient. He earned his Ph.D. in Educational Communications from the Ohio State University.

Read the reviews.


You may also be interested in:

Lifestyle Tips for Warfarin Users

Managing Atrial Fibrillation

The Most Powerful Herb on the Planet

Living With Angina From Coronary Artery Disease

The Fat Loss Diet I Recommend

About Me

Create Your Own Blog

Lifestyle Tips for Warfarin Users

Lifestyle Tips for Warfarin Users



Warfarin (brand names Coumadin and Jantoven) is a prescription medication used to prevent harmful blood clots from forming or growing larger. Beneficial blood clots prevent or stop bleeding, but harmful blood clots can cause a stroke, heart attack, deep vein thrombosis, or pulmonary embolism. Because Warfarin interferes with the formation of blood clots, it is called an anticoagulant. Many people refer to anticoagulants as “blood thinners”; however, Warfarin does not thin the blood but instead causes the blood to take longer to form a clot.


The formation of a clot in the body is a complex process that involves multiple substances called clotting factors. Warfarin decreases the body’s ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. Vitamin K is needed to make clotting factors and prevent bleeding. Therefore, by giving a medication that blocks the clotting factors, your body can stop harmful clots from forming and prevent clots from getting larger.



Measuring Your PT/INR



The INR is the International Normalised Ratio, a measure of how fast blood clots and this evaluates the effectiveness of warfarin in thinning your blood.

Your INR will be measured usually by pricking your finger to obtain a small droplet of blood which is put onto a special strip which can be analysed by a hand-held point-of-care device.


  • In people who are not taking a blood-thinning medicine, blood clots with INR of around 1.0. To reduce the risk of a stroke in atrial fibrillation the blood needs to be 2-3 times thinner than normal.
  • This means that the blood takes 2-3 times longer to clot.
  • If you have atrial fibrillation your target INR range will be 2.0 to 3.0.
  • If your blood is too thick (INR less than 2.0), then you are still at increased risk of having a stroke (caused by a clot).
  • If your blood is too thin (INR greater than 3.0), then this increases your risk of bleeding.
  • Some people attend a clinic (either at the hospital or their GP or health centre) to have their INR monitored. Other people self-monitor and/or self-manage their INR at home but this is not suitable or possible for all patients. If you wish to self-manage your INR you need to discuss this with your doctor.
  • When you first start warfarin it may be necessary to have your INR monitored every week but once your INR becomes therapeutic (in the INR range of 2.0 to 3.0) and is stable in that range, when you will only need to have INR checked every 4 to 6 weeks. Remember, it is very important to keep your INR in the recommended range of 2.0 to 3.0.



Managing Your PT/INR Range


To help Warfarin work effectively, it is important to keep your vitamin K intake as consistent as possible:

Sudden increases in vitamin K intake may decrease the effect of Warfarin.

On the other hand, greatly lowering your vitamin K intake could increase the effect of Warfarin.



To keep INR / PT stable and within the recommended range, it is important to:


  • take the correct dose of Warfarin at the same time every day
  • have your INR / PT checked regularly
  • keep your vitamin K intake consistent from day to day



To help make it easier to keep your intake of vitamin K consistent:


  • limit intake of foods considered “high” in vitamin K to no more than 1 serving each day
  • limit intake of foods “moderately high” in vitamin K to no more than 3 servings each day
  • report any significant changes in your diet or your weight to your doctor


In other words,

  • Watch how often you eat foods high in vitamin K.
  • Watch how much you eat of foods high in vitamin K




Watching Your Vitamin K Intake


Green leafy vegetables are among the best food sources of vitamin K. The average intake of vitamin K for most adults in the U.S. is 70 to 80 micrograms (mcg) per day.

The Daily Value for vitamin K, an estimate of daily need, is 80 micrograms. The Percent Daily Values (%DV), listed on the tables below, help consumers determine if a food contains a little or a lot of a specific nutrient.

It is important to limit intake of foods that provide more that 60% of the Daily Value for vitamin K to help keep INR/PT in the desired range.



Foods high in Vitamin K (more than or equal to 200% DV)

Eat no more than 1 serving per day


Food                                                               Serving size                     % Daily Value

Kale, fresh, boiled                                     1/2 cup                                 660

Spinach, fresh, boiled                             1/2 cup                                  560

Turnip greens, frozen, boiled              1/2 cup                                   530

Collards, fresh, boiled                            1/2 cup                                    520

Swiss chard, fresh, boiled                     1/2 cup                                    360

Parsley, raw                                                 1/4 cup                                   300

Mustard greens, fresh, boiled             1/2 cup                                    260




Foods moderately high in Vitamin K (60 to 199% DV)

Eat no more than 3 servings per day


Food                                                              Serving size                           % Daily Value

Brussels sprouts, frozen, boiled             1/2 cup                                190

Spinach, raw                                                    1 cup                                   180

Turnip greens, raw, chopped                    1 cup                                   170

Green leaf lettuce, shredded                     1 cup                                   125

Broccoli, raw, chopped                                 1 cup                                  110

Endive lettuce, raw                                         1 cup                                      70

Romaine lettuce, raw                                     1 cup                                      70


Iceberg lettuce, red cabbage, asparagus, and soybean oil are often reported as being high in vitamin K. They contain much smaller amounts than foods listed in the tables above. These, and other foods and beverages not listed in the tables above (including coffee and tea), may be consumed as desired.

The above food values are from the U.S. Department of Agriculture, Agricultural Research Service. 2003. USDA National Nutrient Database for Standard Reference, Release 16.



Alcoholic Beverages and Warfarin



Alcohol intake greater than 3 drinks daily can increase the effect of Warfarin. However, some medical doctors advise those taking Warfarin to avoid all alcoholic beverages. Check with your doctor about this issue.

One drink = 5 ounces wine

12 ounces beer

1 1/2 ounces liquor



Supplements and Herbs


Many dietary supplements can alter the INR/ PT.

Dietary supplements known to affect the INR/PT include: arnica, bilberry, butchers broom, cat’s claw, dong quai, feverfew, forskolin, garlic, ginger, ginkgo, horse chestnut, insositol hexaphosphate, licorice, melilot (sweet clover) pau d’arco, red clover, St. John’s wort, sweet woodruff, turmeric, willow bark, and wheat grass.

Much is unknown about dietary supplements. The safest policy is for individuals on Warfarin to avoid all dietary supplements unless their physicians approve. This includes any vitamin/mineral supplements that list vitamin K on the label. If they are taken regularly on a daily basis, they pose less of a problem than if taken off and on.



Vitamin E Supplements and Warfarin


Evidence suggests that vitamin E has blood-thinning effects. Vitamin E intakes above 1,000 International Units (IU) per day may increase the risk of excess bleeding. Research suggests that doses up to 800 IU may be safe for individuals on Coumadin®, but the evidence is not conclusive. It is best for those taking Warfarin to ask their physicians about taking Vitamin E supplements.






Beat Your A-Fib by Steve S. Ryan, PHD



Antiobiotics and Warfarin


Many antibiotics and related medications, including azole antifungal agents, heighten warfarin’s blood-thinning ability and raise the risk of internal bleeding. Some antibiotics, such as rifampin, decrease warfarin’s ability to “thin” the blood, increasing the risk a blood clot will form. People taking warfarin and antibiotics must be monitored closely. That’s why if you are prescribed an antibiotic to treat or prevent an infection, you should immediately tell the clinician who manages your warfarin.

“Monitoring is key. It is important to maintain a level of warfarin that is high enough to prevent unwanted blood clots without overly increasing the risk of bleeding,” says Dr. Tejal Gandhi, associate professor of medicine at Harvard Medical School and an expert on outpatient drug safety.

In a recent study of 38,762 Medicare patients taking warfarin, researchers found that azole antifungals and all classes of antibiotics increased the risk of bleeding within two weeks, but to different degrees (American Journal of Medicine, February 2012).

The drug classes are listed in the chart below, along with their risk of interaction (4.57 = the drug increases the risk of bleeding more than 4 times over that of a warfarin user who is not taking this particular drug).

Risk of a drug-drug interaction varies

Many patients think drug interactions are only caused by pills, but topical antibiotics are absorbed into the bloodstream and can interfere with warfarin, too.

This includes ointments, creams, and suppositories. “A common cause of a rise in the INR is antifungal cream prescribed to women with a vaginal yeast infection,” says Massachusetts General Hospital’s Lynn Oertel.


Most physicians are aware of the potential for warfarin-antibiotic interactions, and they discuss the risk with patients when warfarin is prescribed. Nevertheless, as a caregiver, you an be an important safety net, as there are plenty of opportunities for error:


  • A patient may not understand the potential significance of this drug-drug interaction, or may simply forget.  A provider who prescribes the antibiotic may fail to inform the clinician managing the patient’s warfarin.


  • Monitoring is advised, but the patient may not comply with INR testing.


  • The drug-interaction alert function in the physician’s computerized medical records system is not turned on, or the medication lists are out of date.


  • The patient uses two different pharmacies for filling the warfarin and antibiotic prescriptions, preventing the pharmacist from issuing a warning.


  • The patient receives an antibiotic sample or handwritten prescription from the physician, bypassing any computer system that might alert providers to a potential drug-drug interaction.




The Three Most Important Points


  • Warfarin is a very important drug for you. Follow the prescription exactly, and keep your follow-up appointments for blood tests such as the INR/PT.


  • Warfarin interacts with vitamin K in your body, so you need to keep vitamin K intake constant from day to day. It is also important to avoid herbal products and dietary supple­ments that may affect vitamin K and Warfarin unless approved by a qualified health care provider.


  • Post the phone numbers of your doctor, pharmacist, and registered dietitian for ready reference when you have a question or concern about Warfarin, vitamin K, and your INR / PT.



US National Library of Medicine. Medline Plus: health topics. Available at:



Beat Your A-Fib: The Essential Guide to Finding Your Cure: Written in everyday language for patients with Atrial Fibrillation by Steve S. Ryan, PhD

Many patients suffering from Atrial Fibrillation have three strikes against them:

1. Their “quality of life” has deteriorated; they are scared or frightened.

2. Many experience side effects from the common drug therapies or simply do not want to live on medication; a cure for their A-Fib hasn’t been discussed.

3. Patient information is often out-of-date, incomplete or biased toward a specific pharmaceutical or treatment; much information about new treatment options is written in the language of scientists and doctors.


The author, Dr. Steve Ryan, PhD, a former A-Fib patient, addresses all these issues. His book is written for the newly diagnosed patient and any A-Fib patient who doesn’t want to wade through medical texts and research journals to understand their disease.

Beat Your A-Fib helps patients and their families look beyond the commonly prescribed drug therapies that only manage the disease, but do not cure it.


Beat Your A-Fib: The Essential Guide to Finding Your Cure offers:


  • Unbiased, up-to-date information and best practices
  • Medical terms and concepts translated into everyday language
  • Non-drug treatment options including Cardioversion, RF catheter ablation, Pulmonary Vein Isolation, CryoBalloon, Cox-Maze and Mini-Maze surgeries, and AV Node Ablation with Pacemaker
  • Research-based content with a bibliography of over 150 medical references
  • ‘Lessons learned’ from A-Fib patients now enjoying lives free of the burden of A-Fib
  •  Recommended Resources and Website Links
  • Patient tools to become their own best healthcare advocate


This unique book helps patients research their best treatment options, steps through how to find the right doctor for their type of A-Fib and treatment goals, gives patients hope and empowers them to develop a plan for finding their A-Fib cure or best outcome.

Dr. Walter Kerwin, MD, of Cedars-Sinai Medical Center Los Angeles, California, wrote the Foreword for the book. Dr. Steven C. Hao, MD, of California Pacific Medical Center, San Francisco, California, penned the Introduction.

Dr. Steve Ryan, PhD, is a noted healthcare educator and advocate for patients with Atrial Fibrillation, and former A-Fib patient. He earned his Ph.D. in Educational Communications from the Ohio State University.

Read the reviews.





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Living With Angina From Coronary Artery Disease

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Living With Angina From Coronary Artery Disease

Living With Angina From Coronary Artery Disease




Angina is a type of coronary artery disease. The coronary arteries bring oxygen-rich blood to the heart. Because the heart is a muscle, it needs oxygen to work well. In coronary artery disease, one or more of these arteries may be partially or even completely blocked.

Stable and unstable angina do not always lead to a heart attack, but both should be given medical attention.


In coronary artery disease, blockages—made up of fats, such as cholesterol, and other debris—form on the inside walls of the arteries.


In stable angina, the blockages may not seriously block the flow of blood and this condition usually doesn’t damage the heart.


In unstable angina, the blockages may be large and can lead to a heart attack.


Having either stable or unstable angina does not always mean your loved one will have a heart attack, but angina can be serious and should be treated by a doctor.



Chest Pain Can Be An Emergency

Angina is caused by a lack of oxygen in the heart muscle. Symptoms include pain or discomfort in the chest, arms, back, neck, or jaw.

Sometimes, anginal pain may feel like a tight or crushing sensation, or it may be a stabbing pain or numbness. Some people mistake anginal pain as indigestion or gas pain.



Here are some signs that your loved one’s angina is serious and that he or she should go to the hospital right away:


  • Pain or discomfort that is very bad, gets worse, and lasts longer than 20 minutes.
  • Pain or discomfort along with weakness, nausea, or fainting.
  • Pain or discomfort that is worse than your loved one has ever had before.


If you loved one has already been diagnosed with coronary artery disease and takes nitroglycerin to help manage his or her condition, any pain or discomfort should go away after he or she takes three tablets in 15 minutes. If it doesn’t, your loved one needs to go to the hospital right away.

If you live in an area where ambulance service is not quickly available, someone should drive your loved one to the nearest hospital. He or she should not drive.



Treatment of Unstable Angina

If your loved one experiences severe chest pains, his or her doctor will want to run a series of tests. After the tests, you, your loved one, and the doctor can decide on the best course of treatment.

In general your loved one will have three choices: medical therapy, angioplasty, or bypass surgery.



Medical Therapy



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Several types of medicine—including a daily low dose of aspirin, nitrates, and beta blockers (both by prescription) — can help relieve the discomfort of unstable angina.

Some of these drugs make it easier for the heart to work, but none of them removes blockages from the arteries. They simply relieve anginal discomfort by bringing more blood to the heart.

Medical therapy may be used alone or in combination with other treatments—but many people with unstable angina do very well on medicine alone.


Medical therapy may benefit your loved one if he or she:

  • Has a blockage or blockages in only one vessel
  • Has a less severe blockage
  • Does not have severe anginal discomfort


Questions To Ask About Medical Therapy

  • What side effects will the medicine cause?
  • Will my loved one have to take medicine for the rest of his or her life?


Some people have uncomfortable side effects from the medicine, but most feel better because they have less anginal discomfort. If your loved one does have a reaction to a medicine, be sure his or her doctor knows about it. Often the reaction goes away or becomes less severe with time. If not, the doctor may be able to change the medicine to make your loved one more comfortable.

If your loved one continues to experience anginal discomfort while taking his or her medicine, he or she may need to discuss the possibility of angioplasty or bypass surgery with his or her doctor.




In angioplasty, a thin tube called a catheter is inserted into an artery in the groin and threaded up to the blocked artery. This catheter has a very small balloon attached to the end. When the catheter gets to the blockage, the doctor inflates the balloon. When the balloon is deflated, the blockage should open enough for blood to get through, stopping the anginal discomfort.


Possible Benefits Of Angioplasty

  • Relieves your loved one’s anginal pain
  • Increases your loved one’s ability to be active and exercise
  • Allows your loved one to return to former activities
  • Reduces the amount of medicine that your loved one has to take


Possible Risks Of Angioplasty

  • Worsened angina
  • Emergency bypass surgery
  • Heart attack
  • Damage to the artery
  • Re-blockage of the artery
  • Death


Questions To Ask About Angioplasty

  • Will my loved one need additional angioplasty or bypass surgery in the future?
  • What are the chances that my loved one might die during the procedure?
  • What other complications or problems may result from the procedure?



Bypass Surgery

Surgery is usually recommended for people who have severe blockages in the left main coronary artery or disease in several vessels. Surgery is also an option when medicines do not control anginal symptoms.

Coronary artery bypass surgery can be a very effective way to increase the amount of blood getting to your loved one’s heart, which should stop his or her anginal discomfort.

In this operation, a piece of a vein, usually from a leg or another artery in the chest, is removed and used to “bypass” the blocked section. One end of the blood vessel is placed into the aorta (the artery that supplies all the blood going out of the heart and into the body). The other end is sewn into the artery below the blocked section to bypass the blockage.




Questions To Ask About Bypass Surgery:

  • What will it feel like to have bypass surgery?
  • What is the chance that my loved one might die during surgery?
  • What other complications or problems may result from the procedure?
  • Will my loved one need more surgery in the future?



Can Blockages Come Back?

Neither angioplasty nor bypass surgery is a cure for coronary artery disease. Blockages continue to build up on artery walls after either procedure. Both angioplasty and bypass surgery can be repeated if the arteries become blocked again, but the only way to stop coronary artery disease is to prevent more blockages from building up.

Your loved one’s doctor may recommend that he or she attend a cardiac rehabilitation program. These programs usually are offered by local hospitals and very often they are covered by insurance.

In a rehabilitation program, nurses, exercise specialists, and doctors will help your loved one change behaviors that put him or her at a higher risk for future artery blockages. They will also teach your loved one how to exercise safely and help him or her gain confidence in his or her ability to live with heart disease.



Preventing Blockages

The best way to prevent blockages is to:

  • Eat foods that are lower in fat
  • Increase physical activity



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The American Heart Association’s cornerstone cookbook has sold more than three million copies and it’s now fully updated and expanded to reflect the association’s latest guidelines as well as current tastes, with a fresh focus on quick and easy.

This invaluable, one-stop-shopping resource — including updated heart-health information, strategies and tips for meal planning, shopping, and cooking healthfully — by the most recognized and respected name in heart health is certain to become a staple in American kitchens. Read reviews at Amazon.




Living With Coronary Artery Disease

Coronary artery disease does not go away. Your loved one’s behavior and lifestyle will affect his or her condition. This is why it is important for you to encourage your loved one to follow his or her doctor’s advice.

It’s normal for you to worry about your loved one’s health and future, but you should know that most people with unstable angina do not have heart attacks. Usually, angina becomes more stable within eight weeks. In fact, people who are treated for unstable angina can live productive lives for many years.

Coronary artery disease can be very difficult to deal with emotionally. Both you and your loved one may feel a loss of control, as if something had taken over your lives. Doctors, nurses, members of the clergy, and counselors all have experience in helping people with coronary artery disease. They can help you and your loved one deal with this difficult condition.







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