Lone AFib – Exercise Cool Down and Swallowing as Trigger?

webmd_rf_photo_of_atrial_fibrillationI’m in my mid 40s and exercise very regularly. And when I say regularly, I mean very regularly… (see Working out 7 Days a Week?!). About 7 years ago (years before I started my more intense exercise routine), I had my first episode of atrial fibrillation (AFib), which feels somewhere between weird and scary. At the time, I started going through all kinds of EKGs, ultrasounds and other tests (you name it). The end result: my heart is healthy, I have no other risk factors and I don’t abuse drugs or alcohol. The official term for this is “Lone AFib” (LAF), which basically means nobody knows where it comes from or what causes it.

Since then, I’ve now had a total 4 episodes:

  • I ended up in the ER every time.
  • Gaps in between were 4 years, and roughly 21 months thereafter.
  • The first time I was admitted and converted back to normal sinus rhythm due to drugs overnight. The 2nd time I enjoyed a cardioversion (read: defibrillator & electroshock). The 3rd and 4th time I spontaneously converted while already in the ER but without clear reason – maybe it was the stress of the ER experience or that the Flecainide ended up working after all. (After the first incident, my doctor advised me to take Flecainide only in case I go into AFib, not as permanent treatment.)
  • I stayed in AFib between 8 and 23 hours during those episodes.

Coming back to the mysterious trigger, there seems to be a common pattern that emerges from the various circumstances when my AFib episodes started:

  • Walking off the mat after a Tae Kwon Do class on a Saturday morning and taking a swig from my water bottle (2 occasions, exact same situation and day and time of day!).
  • Coming home from a jog and getting something to drink.
  • Sitting down after a hike up a mountain and starting to sip water.

It seems obvious: the 2 factors that always appear to come together are 1) finishing cardio-intensive exercise (the heart going into recovery from high BPMs) and 2) swallowing liquid. I’m wondering if the nerves controlling the swallowing reflex/process (vagus nerve?) intersect with or related to the part of the nervous system controlling the heart rate or if there is another way these two bodily processes relate?

From what I’ve read and the doctors I’ve talked to, there is no clearly documented connection. And yet at least for me this pattern is obviously way too consistent to be coincidental.

I’d love to hear from others who’ve been diagnosed with “Lone AFib” as to whether they’ve experienced the same or similar patterns?

On a sidenote: has anyone found that Flecainide affects the blood sugar level (a maybe undocumented side effect)?

Please respond with comments.

Working out 7 Days a Week!?

If you’ve read my earlier post about losing weight, you’ve already heard about the boost to my workout routine. At this time, I’ve been working out 7 days a week for – I’m not even sure – 2 years or so (apart from 1 day, as far as I can remember). Yes, you’ve read that right: 7 days a week! No matter the weather, rain or shine, whether I’m traveling, domestically or internationally, vacation or work days, sick or not. When I’m on the road and my day daily routine is off, I make it happen, even if it’s at 5 in the morning or 10 at night.

Why on earth would I do this? Well, it was part of my effort to increase my regular calorie burn. But that’s not all. Exercising, which I normally do after work, helps me refresh and reboot myself after a long day at work and I always feel better afterwards. It’s become part of my daily routine. Without it, I feel cranky, my muscles are tense, and my mind feels tired. Nowadays it’s just part of what I do. Period. Side benefit: coming home from work, my focus is to get out and work out as soon as I can which makes me only eat a quick and light dinner or even replace a meal with a nutritional shake. That makes it much less likely to overindulge on dinner and consume too many calories.
534988_567713383276425_1780417856_nOkay, you might say, but is working out every day healthy? Doesn’t the body need time to recover in between workouts? I thought so too, but I can honestly say that I feel great and energized. I don’t feel my body screaming (or whispering) for an off day, no fatigue or overuse (as far as I can tell). It may have to do with this: If I can help it, I never do the same thing more than 2 days in a row; ideally I do a different form of exercise every day. My main stay is Tae Kwon Do (usually Tue/Wed/Sat). If I’m not in the Tae Kwon Do studio, I go running. If I’m not running, I play tennis. If I’m not playing tennis, I hike or swim laps. In winter, I might be able to work skiing in. Key is I do something at least moderately intense and work up a sweat. Since each of these workouts emphasizes different muscle groups and varies cardio/anaerobic, strength, stretching, etc., I can get away without fatigue and overuse.
Yes, on occasion and injury can occur (I sprain a joint or muscle, etc. – hey, Tae Kwon Do is a contact sport and I’m not 20 any more). Then what? Well, I’ve always been able to work around it. If the knee problems come back that I’ve had since I was 16? I go swimming. Calf muscle is acting up – hiking usually works better than running. Back sore? I’ll find a way to do something that doesn’t aggravate it further. There’s always an exercise I can do, despite my injury.
One thing that did help was changing my running style to that of a minimalist runner. Yes, removing cushioning and going to a mid-foot strike has actually helped me reduce stress on my knees and allowed me to run longer and with less impact. Kind of ironic. Despite the thin soles on my shoes, the changes to the biomechanics greatly reduce joint impact. (For more info, check this out!)
It makes sense that if you challenge your body with a diverse set of different sports and exercises, you’ll obviously increase your overall level of fitness, but without the fatigue and overuse that comes from doing only one or a small number of different exercises. I’m not sure how long I can keep this up, but for now I feel good and am motivated to keep going. It’s what I do.
If anyone else out there has had similar experiences, I’d be curious to learn more. Do tell and leave a comment!

The Scale of the 21st Century

As you might know from previous posts, I’ve been religious about weighing myself to track progress. That’s probably why my scale died. Consequently I was looking for worthy replacements. I recalled seeing the Withings Smart Body Analyzer in the Apple store and ended up ordering it from Amazon.

Remember when the iPhone forced you to rethink what you knew about what a phone was and does? That’s close to how this little miracle device made me rethink what a scale is supposed to do. This thing measures

  • WithingsscaleWeight (duh!) –  in 0.1 lbs increments
  • Body fat % (through induction – at lease directional, but probably not super precise)
  • Heart rate
  • Room temperature and CO2 in 1-hour increments.

After you’re done with measurements, it transmits the info via your WiFi network to a web service whose data you can access via the Withings Healthmate web site or an iPhone app. The latter integrates with Apple’s health app as well as MyFitnessPal. Suffice it to say these services provide you with all the tracking and graphics you could ever hope for – and more. Did I mention the scale automatically recognizes all your family members who can have their own accounts?

This sleep device has worked seamlessly so far and not only made my life easier (no more manual logging of weight etc.), it has also provided additional data and made tracking all this information extremely convenient.

Overall, I’m quite impressed so far. This is what a scale of the 21st century is supposed to do. This makes me curious to see what other companies will come up with disruptive ways to rethink what the electronics and machines around us should really be and do…


Weight Loss for Creatures of Habit

I’ve never seriously considered losing weight, even though over the years my weight slowly increased by a pound a year and my waist size was up 2 inches from where it used to be. At 5’10” with 213 lbs at age 42, I thought I was okay. Hey, I exercised 5 days a week (including intense martial arts, running and tennis), ate decently and was overall pretty healthy. So my weight was probably due to muscles, right?

Beginning the Journey

Whatever it was, in January of 2013 I read something about fitness apps and tracking exercise and calories. On a whim, I downloaded MyFitnessPal and put in my data. I set my target for 200 lbs, which resulted in a daily calorie limit of about 1,800 calories or so. Then I started tracking everything I ate as well as my exercise. Being anal and a little OCD, I quickly became obsessed with making sure all my information was entered properly at all times, including a daily weigh-in. It didn’t take long to realize that 1,800 calories a day isn’t a whole lot. I figured out a number of changes I had to make as far as my diet:


  • Cut out the morning OJ to reduce sugar/carbs.
  • No more Gatorade after my workouts – I found a sugar-free substitute (Sqwincher Qik Stiks).
  • Generally reduce the carbs, even whole wheat variants
  • Watch portion size even more than I already had.
  • Switch to a uber-healthy and low-calorie 9 PM snacks


When I worked out hard, it gave me “calorie credit”, which allowed me to eat a little bit more. So as an admitted creature of habit, I decided to bump up my routine and exercise 7 days a week, even if that meant getting up at 5:30 on Fridays to go running before work (I usually work out at night). 7 days a week sounds harder than it is and with the right routine is quite doable. I thought my body needed rest days, but it adjusted quite well to working out every day. Tracking everything with MyFitnessPal was immensely helpful and educational. It helped me fine-tune what I was doing and identify little mistakes and areas of improvement. With this app-induced awareness, I was able to start dropping pounds quite consistently.

Getting on Auto-Pilot

Routine – in my case – is the key. I tend to follow the same routines and patterns and they become second nature. In order to really be effective and put my diet on auto pilot, I came to the realization that if I just changed my old routine and established a new one, I could get into a mode of sustained weight loss without having to fight too hard for it. Sticking with it is easiest for me if I don’t have to think about it too much, just follow the established routine.
Example: I used to eat at Quizno’s most weekdays. Even their turkey bacon guacamole sandwich had 700-800 calories. This seemed to be okay before, but thanks for MyFitnessPal, I learned that this wasn’t all that great, I So I changed my routine and started going to Subway almost every day, where a ham sandwich with healthy ingredients and no mayo was in the 400-calorie range. I had read the book Change Everything earlier and two key elements helped me:
  • Identify critical moments where I am most likely to go off track and figure out how to avoid falling off the wagon. In my case that was free food catered for meetings at work. So I learned to either walk away (not always easy, especially with free pizza in the lunch room) or reduce the portion size and fill up mostly with salad and just have a little bit of the “bad stuff”.
  • Visit your “default future”, which means envisioning myself and what I would look and feel like if I didn’t do anything about my weight. Not always a pleasant thought. Reversely, I started liking to envision myself “ripped” and with a noticeable 6-pack.


After about 2 months I had fine-tuned my understanding of the foods I ate and the exercise I did on my calorie budget. With my new habits, I stopped tracking food and exercise, but still held on to the daily weigh-in. Due to the heightened overall awareness and knowledge I had built, this didn’t negatively affect my weight trajectory.
As the months were coming and going and my weight was consistently dropping, I kept reaching and surpassing my goals. 213 lbs became 200, my original target. I kept going and reached 190. Nice! How does 185 sound? Doable. But at 185, I figured 180 is a nice round number. At 180 I was stoked. I recalled being at 175 lbs when I was in my late 20’s with a 32” waist. So I kept going and made it to 175! And I still kept going. Since everything happened so automatically and without much effort, it was almost easiest to stick to my routing and the weight would drop by itself.
At this time it’s pretty easy to just keep going and I’ve managed to drop to 173 lbs, which means I dropped 40 lbs (19% of my original weight) in about 18 months, which far exceeds all goals I’ve ever set. I am happy to now have the six-pack and noticeable muscle definition in my core I always wanted. And my waist is down to 31”, even less than in my 20’s.
It’s annoying to have to buy new pants and smaller shirts, but it is rewarding when people come and ask whether I lost weight or comment that I look good or thin.
How long will I keep going? I haven’t figured it out yet, but in the mean-time it’s easiest doing what I’ve been doing and seeing where these new habits lead me.

MFP-screenshot-cropped​My weight over time


There are a number of things I’ve been tweaking and experimenting with throughout my journey and I’m still tinkering with them.
Here are some of the changes and learnings:
  • Fill up with low-calorie vegetables and salads with vinaigrette dressing before hitting the main course. It’s easier to control portion size of “dangerous” items when you almost feel full already.
  • I try to “skip” one meal a day by replacing it with a liquid meal (e.g. avocado/soy milk shake or Glucerna drink) augmented with carrots, hummus etc. for extra volume and satiation. Something in these nutritional / meal-replacement drinks miraculously keeps you full longer too.
  • Not having a steaming meal waiting for me when I come home from work helps. An empty table is far less tempting and helps just reach for a shake and carrots/fruits.
  • Fruits are good, but know they do contain a decent amount of sugar, so don’t overdo it.
  • I don’t skip breakfast and usually have a light lunch. Instead I tend to “skip” dinner and go with a very light 9 PM snack. The body burns calories earlier in the day and not having much for dinner prevents calories turning into fat over-night. On the contrary, going to bed slightly hungry isn’t fun, but you don’t know you’re hungry when you’re sleeping.
  • After a light breakfast, I found out that mixing some whey protein powder into a glass of soy milk keeps me feeling full longer.
  • I snack on unsalted peanuts during the day. I eat way less if they’re unsalted and don’t have to drink as much. I also like Corazonas bars. Snacking on good stuff helps me not feel hungry throughout the day.
  • If you fill up with plenty of liquids, including water, you will feel less hungry.
  • Eating protein in the morning, e.g. egg whites, keep you full longer than carbs or insoluble fiber.
  • My family and I eat out on Friday and Saturday night and I drink lots of Diet Pepsi. I learned that it’s okay if my weight seems to go up over the weekend. Come Monday, I’ll be okay again and continue my slide down.
  • Since we go out for dinner Friday and Saturday night, I switch things on these days and try to skip lunch on those days (read shake). A grande, unsweetened Starbucks iced coffee with soy milk will help me feel full after lunch (and it’s a little reward).
  • I weigh myself at the same time every day to compare “apples to apples”, i.e. right before going to bed.
  • If you want to skip lunch, leave the office and go somewhere, walk around etc. It’ll distract you from the fact that you’re not eating.
  • Nuts and seats are your friend. As a matter of fact, you can turn chia seeds with a few oat flakes, raisins and soy milk into a cereal/snack.
  • Cheese sticks and turkey jerky make good filler snacks. Did I mention carrots yet?
  • Hummus is full of good stuff and low in calories.
  • (Greek) yoghurt is good for you, but watch the sugar.
  • Skip the rice, pasta and other starchy sides and just go for lean meat and vegetables.
  • Watch for rich sauces and dressings or mayo.
  • A little dark chocolate is good for you.
  • When watching TV, I started doing push-ups, sit-ups, crunches, planks, leg lifts, etc. Your body weight is sufficient to build strengths for most of your body – no fancy equipment is needed. (Only exception: biceps. Haven’t figured that part out yet.)
  • I just got a set of resistant bands and am experimenting with different arm and shoulder exercises – also while watching TV. A massage roller can also be a good way to change things up.
  • The more weight I lost, the easier the strength training goes and the longer I can run, which in turn helps burn more calories. This is a self-enforcing cycle in a way.
  • Running in the morning right after getting out of bed is tough on your body. Have a shake or yoghurt before you head out and start slow. My joints tend to ache a little until I stop to stretch 5 minutes into the run. After I start to feel better and my body has finally figured out that the warm bed is now history.
  • I’ve always had knee issues since I was a teenager, but switching to a mid-foot strike instead of heel strike running style paired with light, more minimalist shoes (<= 4 mm heel-to-toe drop, e.g. Brooks PureConnect or Altra “The One”) have helped me run longer and pretty much eliminated my knee issues.
  • Do different workouts and mix it up, so no one part of your body get consistently fatigued. While one part is recovering/rebuilding, the other is getting a workout. I do martials arts, run and play tennis every week. Where possible, I add hiking and swimming. Don’t slack off when you’re traveling.
  • I’d love to use a fitness tracker (Nike FuelBand, Jawbone Up, etc.), but since I can’t wear it during Tae Kwon Do, I’d always be missing out on my main workouts. For running, I like my iPod nano since running with music is more fun and it tracks time and distance. (I tried a heart rate monitor too, but hated the chest strap.)
  • Your weight will fluctuate based on meals, times of eating, how much liquid you’ve had post workout, and other factors. Expect little ups and downs of up to 1 lbs a day even if you “do everything right”. Week over week is a better for comparison purposes and gauging success than day over day.
  • This isn’t a sprint (despite early successes). This is a lifestyle change.
  • Read about working out and nutrition.
  • Get rid of clothes that are now too loose and baggy. It can be fun to get a new wardrobe and you’ll never need those big clothes again, right? If you toss them, you’ve mentally eliminating the “way back”. This should be a one-way street.
These are just my learnings. Your mileage will vary. Key is to figure out what works for you and stick with it. Be open to try new stuff.


Admittedly not everyone is like me. But in my case, building self awareness and creating new habits that become second nature were key to my success. Other people may not be as routine-oriented, but nonetheless, a lot of the things I’ve learned will be transferrable. I feel good (and hopefully look better), am healthy, have good energy, and am happy with the new me. I plan on keeping at it. After all, it’s hard to break with my habits.
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