Underweight and AF risk

[Autumn_Leaves]

I have long suspected there was a connection between being clinically underweight and developing AF. This study appears to confirm this:

pubmed.ncbi.nlm.nih.gov/271...

[secondtry]

Interesting thanks for posting. Key I guess is what are the biological factors that are causing the underweight diagnosis.

[Autumn_Leaves in reply to secondtry]

In my case, I developed orthorexia after a health scare, but the physical reason was actually not eating enough kcal and as I didn’t have much weight to spare anyway, a relatively small weight loss was all it took to reach the clinical underweight threshold. I had no desire to lose weight and I hated it. Even though I recognised that my way of eating wasn’t doing me any good ie the weight loss was actually quite a distressing consequence of “healthy” eating, it was very difficult to gain weight and it took me several years to restore my weight. So there wasn’t an underlying pathology that caused the weight loss other than not eating enough.

The fact is that when someone loses weight, for any reason, they lose muscle and about 50% of that muscle loss is internal, notably cardiac muscle and the musculature of the large intestine. There’s also loss of bone density, which also has implications for long term health.

Obviously there are people who have low body weight because they have serious medical conditions that makes them lose their appetite, or they have trouble swallowing, or their digestive system is compromised, or they have a chronic condition like Crohn’s. I’m sure some pre existing conditions might make some people more vulnerable to developing AF. I may well have had an underlying vulnerability to AF and perhaps my low body weight and that period of weight loss accelerated its appearance. I have no way of knowing. But there are going to be a lot of women and increasingly men who are going to experience the downstream effects of eating disorders and conditions like REDS and hypothalamic amenorrea from overtraining and underfuelling who may be at risk for AF in the future, specifically where these individuals have low body weight over a period of years.

[secondtry in reply to Autumn_Leaves]

Wow you know your stuff! It is so difficult to establish what is causing what. so I will just have to keep 🤞and 🙏.

[Autumn_Leaves in reply to Autumn_Leaves]

I have to give credit to the registered dietitians who post good evidence-based advice and information on their social media platforms. I owe them all a debt of gratitude for the information they make freely available. They mostly specialise in ED recovery and related disorders. I was able to adapt it to my situation. They have no idea how useful their information has been. Perhaps I should send them a message to say thanks. I also have to stress that these are qualified RDs, hospital-trained and working in healthcare settings. DefinItely not ‘influencers’ selling faddy nonsense, and definitely not people with dubious micky mouse qualifications.

I also have to give credit to the NHS dietitian I was referred to by gastroenterology for my digestive symptoms, which relieved a lot of my physical discomfort. It took a lot of discipline and diary keeping, but it helped. I was able to reintroduce foods that were causing digestive symptoms and some I need to limit, but it all made a difference.

But I am now weight restored, so I got there eventually. I do regret restricting food groups and all that nonsense, but a health scare plus peri menopause hormone swings made me vulnerable. I never thought I’d fall for all that nonsense but I now realise that there are many people tripping up their health on silly dietary restrictions. Don’t do it!

[pusillanimous in reply to Autumn_Leaves]

What determines underweight, how is it measured? I come from a slim family, average weight of all females 8st or less, average height 5' 5". We are 5 girls and we all have AF, but then our father also had it and he was not tall 5'9" but weighed over 11st (these are life long weights , with little change from 20s through to 70s and older). It is considered familial, so I am curious about the weight aspect. My mother, who was not affected, never weighed (apart obviously during pregnancy) all her life, more than 7 and a half stone and at her death aged 95, as is often the case, even less.

[Autumn_Leaves in reply to pusillanimous]

I’m also “naturally slim” but underweight is more than just the number on a scale. It’s also about the body habitus, which is about having adequate body fat, musculature and bone strength. Body fat plays an important metabolic role, and in women of reproductive age a very low body fat percentage can result in a drop in the hormones that control the menstrual cycle, which will put those women at a greater risk of osteoporosis and cardiovascular disease at much younger age than the natural menopause. Sarcopenia ie the loss of muscle is not good for anyone’s long term health as it can result in premature frailty, greater risk of falls and fractures, so it’s something that is best avoided. Muscle is also metabolically active tissue which plays an important role in blood glucose metabolism. Muscle loss through underweight also affects the internal musculature, including cardiac muscle and the muscles that control the digestive tract. Loss of bone density is also a serious consequence of being underweight.

These are the sequelae of underweight caused by chronic undernutrition and underfuelling. Obviously if someone is naturally slight in build but they are not physically compromised by chronic under nutrition. it’s clearly not the same thing as someone whose health has been compromised by weight loss to the extent that their body is catabolising itself for fuel.

[RoyMacDonald]

I eat about 5000 calories a day but my weight never changes and I'm underweight as I'm 49 kilos. I've read that it's because I always have porridge for breakfast and that stabilises your weight. Also I've never been able to metabolise fat. ( it makes me throw up if I taste a lot of it)I'm 79 nearly. My AF was diagnosed as being caused by my competitive race training from an early age. It developed when I was about 69 during training.

All the best.

Roy

[Autumn_Leaves in reply to RoyMacDonald]

I’m not good with digesting fat either. Fatty foods make me feel bilious for hours, and I’m talking about the “healthy” foods like oily fish. I’m OK with nuts but they are so fibrous and probably pass straight through anyway.

[MarkS]

That's only part of the story. Being either underweight (BMI 20 both increase risk of AF. I.e. it's a U shaped curve with the lowest risk at a BMI of 20. Someone who is obese with a BMI of over 35 has a 120% increased risk.

So most people who develop AF could do with losing some weight.

[Autumn_Leaves in reply to MarkS]

Yes, but obesity and overweight are well known risk factors in AF. Weight loss advice is ubiquitous in healthcare, to the extent that it becomes invisible. As someone who spent several years being clinically underweight or just hovering at the threshold of BMI 18.5, it’s practically impossible to find advice on how to gain weight in a healthy way. It’s actually very difficult for underweight people to gain weight because the digestive system becomes dysfunctional because of the weakening of the large intestine which results in very slow transit of food, which is also very uncomfortable. Like feeling uncomfortably full and distended all the time. I had to find my own way. But as you say, a U shaped curve = increased risk for underweight people too. But an absence of good quality health advice for people in that situation.

[Redmakesmehappy]

I am underweight and my EP told me to add a scope of pure protein whey to my smoothie I drink daily. Did that for over a year and didn’t gain a ounce. I believe that keep me from getting hungry so I ate less rest of the day. Never had a big appetite anyway, always been tiny with small frame. I am now about 95-97 pounds. The doctors call me frail and have told me I would not be a good candidate for any surgery I might need. I eat mostly vegetables but have a sweet tooth. My cardiologist even suggested I eat ice cream that didn’t help either. I do live alone since my husband died. I think Flecainide has killed what little appetite I had as I lost about 9 pounds since starting it couple years ago. Tried to use it just for PIP but started having more AFib so told to take regularly. I would love to get to 110, maybe make and eat more yeast rolls.

[Autumn_Leaves in reply to Redmakesmehappy]

One scoop of protein powder isn’t going to make much difference! Not to your weight anyway. It may help preserve your muscle mass which is important as we get older as our bodies find it harder to make more muscle and we’re also more prone to losing muscle too. The advice for protein intake for people over 60 or 65 is 1.2–1.4g of protein per kg of body weight, and the studies coming out of Aberdeen University suggest that older people need around 25g of protein at each meal, but I’m not so sure of the details of that study. So it’s a good thing to add in some protein anyway regardless of weight.

It’s also a good idea, if you can, to do a little bit of resistance/weight exercises even if it’s just using baked bean tins as weights just to preserve muscle. There are lots of exercises online for “seniors”, chair based, etc.

It’s really difficult to gain weight and I’ve had that experience of adding what I thought were high density foods that made no difference. I’ve kept all those add-ons in my regular diet including the protein powder, nuts, full fat kefir etc. Larger portion sizes probably helped. The problem with eating more is feeling uncomfortably full all the time. It took me maybe 7-8 years to get back to where I was, so I think it’s just perseverance.

I have my non-negotiables ie three full meals every day, at the same times and each about the same in calories, so that means quite a large breakfast and lunch. I’m rarely hungry so I don’t snack between meals but some health professionals advise two snacks per day between meals. So I’ll eat at my scheduled times regardless and I think that is probably what gets results. Like you I eat a lot of veg, as I follow a plant based diet, which I enjoy and prefer, and I also accept it’s not for everyone. But it is very filling and less energy dense, so it’s not a diet that piles on the pounds very easily.

I wish you well with your weight gain. It IS possible to get there but it’s not easy and it’s not quick in my experience.

[Redmakesmehappy in reply to Autumn_Leaves]

thank you for your advice. I get discouraged as I find it hard to eat when I am not hungry. I need a shoulder and hip replaced but surgeons want consider it at my weight. I use to keep a big yard but find it hard to do anything because of joint pain. I will increase my protein, was concerned about using too much , I am almost 85

[Autumn_Leaves in reply to Redmakesmehappy]

I share your concerns. I also want to be weight restored and more active, better level of physical fitness, more muscle strength, etc etc, because there will be a time to consider ablation or other procedures and physical fitness and being in better body condition overall would help with a better recovery and a more successful outcome. These days I think in terms of lifestyle being a type of “pre-hab” but the irony is that it’s harder to get fit and strong as we get older but more likely we’ll need surgery for something.

[GrannyE]

interesting article. Thanks for posting. I have always said that it is better to have a little bit of spare cos when we get ill we can survive it better. My BMI is 19.4 first thing in the morning.

[Redmakesmehappy in reply to GrannyE]

you are correct, if you get sick most people drop weight fast. Isn’t it odd how some folks can eat even if they are not even hungry and some are the opposed . I will keep trying.