Today’s Dietitian
Vol. 28 No. 1 P. 12
Atrial fibrillation, also known as AFib or AF, is a common heart condition that presents as a fast and irregular heartbeat.1 It can be difficult to manage both physically and financially, and can decrease quality of life as well as life expectancy.1 AF affect 59 million people worldwide and is more commonly seen in white individuals 45 years or older; lifetime risk is lower for Chinese and Black individuals with a slightly higher risk of development in men.2 According to the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) consortium, made up of 66,951 individuals, the risk is highest for those who smoke, have an elevated BMI, hypertension, or a history of heart attack.3,4 The symptoms of AF include fatigue, difficulty breathing, chest pain, dizziness, and cognitive impairment.3,5
As with many diseases, early detection and intervention are key to managing symptoms and improving long-term outcomes.2 Lifestyle interventions are an important part of the management process, as AF is influenced by metabolic disease and modifiable factors like diet, sleep, smoking, sedentary lifestyle, and alcohol overuse.2 A simple way to think of AF care is the ABCs: A is for anticoagulation/avoid stroke, B is for better symptom management, and C is for cardiovascular and comorbidity optimization. Lifestyle modification has recently been touted as an unofficial fourth pillar or letter.4 Mismanagement of AF can lead to an increased risk of stroke, heart failure, and an increased risk of cardiovascular morbidity and mortality. Without proper intervention, the number of individuals living with AF is expected to double or triple by 2050.5
Pathophysiology & Nutrition Link
AF develops when there is cardiac remodeling in the atria, which alters the structure and the electrical output.5 Structurally, this results from a change in the muscle cells and supporting tissues, while electrical changes are attributed to tachycardia and short recovery times.5
Individuals with AF are five times as likely to experience stroke than their healthy peers.3 Many different components of nutrition can impact heart health, such as fiber intake, electrolyte imbalance, anti-inflammatory foods, coffee, and alcohol.4
Dietary Patterns and Atrial Fibrillation
Many different diets have been investigated for their potential benefit in managing AF, and the two patterns with the most evidence to support them are the Mediterranean diet (Med diet) and whole food plant-based diets.3 Commonalities between these two dietary patterns include foods high in fiber, unsaturated fats, and antioxidants.
Studies have been conducted on the ketogenic diet and intermittent fasting regarding their potential impact on AF prevention; however, the lack of fiber in the keto diet, risk for certain nutritional imbalances, and potential difficulty adhering to both dietary plans longer term could be barriers to success.4
Mediterranean Diet
The prime tenets of the Med diet are a focus on whole grains, vibrant produce, lean proteins, and inclusion of healthy fats from fish, oils, and nuts/seeds. Both the PREDIMED study and the continuing PREDIMAR trial indicate that this eating pattern may decrease epicardial adipose tissue, which can be both a risk factor for AF as well as a symptom of chronic AF.3 A 2022 case-control study indicated that the majority of individuals who develop AF consume a diet that is poor or improvable per the Healthy Eating Index.6 The Med diet is naturally anti-inflammatory and high in dietary fiber, both of which are associated with improved heart health.
Whole Foods Plant-Based Diets
A whole foods plant-based diet is like the Med diet, but with fewer animal products and limited processed foods, added sugar, and salt. More research needs to be done to determine its effectiveness of treating AF, but it may offer some benefit for individuals at high risk of developing AF.3 Prior studies have shown the benefits it provides, such as reducing the risk of hypertension, improving blood sugar control and insulin resistance, aiding in weight management, decreasing inflammation, and preventing oxidation.3,7,8-10 It’s important to note that research showing benefits has focused on whole foods like beans, lentils, whole grains, and produce and not processed foods like plant-based meat replacements, snack foods, or vegan desserts.
Key Nutrients & Dietary Factors
A 2024 review investigated the association between specific foods and nutrients on risk of developing new onset, postoperative, and recurrent AF.11 They drew the following conclusions11:
- Chocolate, caffeine, salt, fish, vitamins C and D, and magnesium had a neutral impact on new onset AF.
- Alcohol and high-dose, long-term omega-3 polyunsaturated fatty acid supplementation was associated with an increased risk of developing new AF.
- A dietary pattern rich in vitamins C and D and omega-3 fatty acids were associated with a decreased risk of developing post-op AF.
- Alcohol was associated with an increased risk of recurrent AF.
More research is needed to better understand the mechanisms and need for supplementation vs dietary intake of certain nutrients.
Electrolytes
A 2024 observational study published in BMC Genomics found a correlation between low magnesium and potassium and risk of developing AF; individuals with elevated phosphate also had a higher prevalence of AF.12 Potassium and magnesium are responsible for supporting electrical stability in the body, while phosphate aids in energy production, bone and tooth formation, acid-base balance in the body, and intracellular signaling.12 Consuming more than 6 g of sodium per day was associated with a 10% higher risk of AF. For each additional gram of sodium consumed beyond that, the risk increased by another 10%.13
Alcohol & Caffeine
Much conflicting research surrounds caffeine and AF, as caffeine is both a stimulant and also contains a number of polyphenols (particularly in coffee) that function as antioxidants.4 Individual risk and response varies, and it’s prudent to discuss potential harm with clients at their current intake level.4 Most individuals can safely consume up to 300 mg of caffeine daily with no repercussions, although caffeine in excess may shorten the refractory period and can lead to an elevated heartbeat.4
There is a strong association between alcohol and AF as ethanol can exacerbate oxidative stress; it can also shorten the atrial action potential, which can lead to tachycardia.4 Drinking in excess will perpetuate these symptoms, and a phenomenon known as “holiday heart” is recognized in this population. Holiday heart occurs around the holidays and vacation, when alcohol consumption may be higher and leads to an increased risk of AF.4
Fats
There is mixed evidence on the impact of fat on AF prevention and development. A 2024 review indicates that for those with metabolic syndrome or related conditions, supplementing with omega-3 fatty acids may increase risk of development of AF.14 Large dose supplementation (≥1 g per day) is associated with a 50% increased risk of developing AF, while small dose (≤ 1 g per day) is associated with a 12% higher risk.14 Other observational studies have noted that a diet rich in omega-3 containing fish does not necessarily prompt the same response, raising more questions about diet vs supplementation.14
Clinical Applications & Counseling Strategies
Ideally, clinicians should focus on making small, sustainable changes to a client’s overall dietary pattern, not an increase in isolated nutrients, particularly via supplementation. Employing strategies to combat modifiable risk factors like physical activity, sleep hygiene, adequate (not excessive) nutrient intake, smoking cessation, and alcohol moderation are key to lasting change.15 Tailoring all strategies to complement the client’s other potential comorbidities is also helpful to streamline recommendations and hopefully increase long-term success.
Conclusion
While nutrition alone cannot cure AF, it can be an important part of both the risk reduction and management strategy. Research supports the implementation of nutrient dense, heart-healthy dietary patterns like the Med diet for both prevention and better long-term outcomes. More research is needed on the use of supplements and in a wider and more diverse population, but clinicians can and should confidently integrate nutrition counseling into AF management.
— Alexandria Hardy, RDN, LDN, is a writer, early intervention therapist, and the owner of Pennsylvania Nutrition Services, an insurance-based private practice located in Lancaster, Pennsylvania.
References
1. Nabil MA, Rychlik L, Nicholson A, et al. Dietary interventions in the management of atrial fibrillation. Front Cardiovasc Med. 2024;11:1418059.
2. Linz D, Gawalko M, Betz K, et al. Atrial fibrillation: epidemiology, screening and digital health. Lancet Reg Health Eur. 2024;37:100786.
3. Kuipers MF, Laurila R, Remy ML, et al. Exploring diet-based treatments for atrial fibrillation: patient empowerment and citizen science as a model for quality-of-life-centered solutions. Nutrients. 2024;16(16):2672.
4. Leszto K, Frąk W, Kurciński S, et al. Associations of dietary and lifestyle components with atrial fibrillation. Nutrients. 2024;16(3):456.
5. Nesheiwat Z, Goyal A, Jagtap M. Atrial fibrillation. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025. https://www.ncbi.nlm.nih.gov/books/NBK526072/
6. Neumann FA, Jagemann B, Makarova N, et al. Mediterranean diet and atrial fibrillation: lessons learned from the AFHRI case-control study. Nutrients. 2022;14(17):3615.
7. Alexander S, Ostfeld RJ, Allen K, Williams KA. A plant-based diet and hypertension. J Geriatr Cardiol. 2017;14(15):327-330.
8. Lee YM, Kim SA, Lee IK, et al. Effect of a brown rice based vegan diet and conventional diabetic diet on glycemic control of patients with type 2 diabetes: a 12-week randomized clinical trial. PLoS ONE. 2016;11(6):e0155918.
9. Haghighatdoost F, Bellissimo N, Totosy de Zepetnek JO, Rouhani MH. Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta-analysis of observational studies. Public Health Nutr. 2017;20(15):2713-2721.
10. Esselstyn CB. A plant-based diet and coronary artery disease: a mandate for effective therapy. J Geriatr Cardiol. 2017;14(5):317-320.
11. Gawałko M, Middeldorp ME, Saljic A, et al. Diet and risk of atrial fibrillation: a systematic review. Eur Heart J. 2024;45(40):4259-4274.
12. Wu Y, Kong XJ, Ji YY, et al. Serum electrolyte concentrations and risk of atrial fibrillation: an observational and mendelian randomization study. BMC Genomics. 2024;25(1):280.
13. Johnson LS, Mente A, Joseph P, et al. Sodium intake and incident atrial fibrillation in individuals with vascular disease. JAMA Netw Open. 2024;7(7):e2421589.
14. Herrmann W, Herrmann M. n-3 fatty acids and the risk of atrial fibrillation, review. Diagnosis (Berl). 2024;11(4):345-352. 15. Nalliah CJ, Sanders P, Kalman JM. The impact of diet and lifestyle on atrial fibrillation. Curr Cardiol Rep. 2018;20(12):137.