THE 6 KEYS TO FASTING SAFELY WITH HEART DISEASE

If you have heart disease, fasting is a powerful tool you can use to help heal your heart—but you may need to take extra precautions to make fasting safe and effective.

Treating chronic disease

Common kinds of heart disease include elevated cholesterol, high blood pressure, and coronary artery disease. Congestive heart failure occurs when malfunction of the heart muscle leads to a buildup of fluid in the lungs, resulting in shortness of breath. And there are disturbances of the rhythm of the heart, most commonly atrial fibrillation.

These conditions all share underlying causes, such as inflammation, excess visceral fat, metabolic dysfunction, immune dysregulation, and intestinal permeability. Other chronic diseases, like autoimmune diseases, diabetes, cancer, and stroke, are often associated with aging because their causes accumulate and progress as we get older. While medicine has had great victories eliminating or curing acute illness, like infections and trauma, the best conventional treatment can do for chronic diseases is to manage the symptoms and complications while the underlying problems progress.

That doesn’t mean we can’t treat chronic conditions; it means that we must treat them through prevention and lifestyle changes, like exercise, diet, and of course, fasting. But because fasting is a stress on the body, people with heart problems may experience complications or worsening of symptoms with fasting.

It just takes a little planning

It isn’t difficult to make fasting safe for people with heart disease, it just takes a little planning.

There are several important things to consider when planning your fasts. Staying hydrated, but not over-hydrating, can be tricky. And if you’re not used to fasting and you overly stress your body with a fast that’s too strict or too many days, this may provoke worsening symptoms or, worst-case scenario, a heart attack.

There are 6 things anyone with heart disease must do to enjoy the benefits of fasting while controlling the risks:

1. Work in collaboration with a doctor who understands you, your heart problem, and fasting.
2. Pick the dose of fasting best suited to your situation and health needs. See more on fasting dosage in my recent post, How to Get Started With Fasting.
3. Increase the length of your fast as your resilience increases.
4. Monitor your blood pressure and manage your blood pressure medications with your doctor.
5. Monitor your heart rhythm.
6. Be mindful of the possibility of both dehydration and salt overload.

Work in collaboration with a doctor who understands you, your heart problem, and fasting

Not all doctors will be on board with your decision to fast. Some will suggest that it is unproven therapy. In fact, fasting has as much scientific data supporting it as do 90% of the things that doctors recommend for their heart patients. What fasting doesn’t have is a strong voice in the medical establishment. This is the same medical establishment that clings to the notion that saturated fat causes heart disease and barely challenges the processed food industry that drives so much of the epidemic of heart disease, diabetes, and obesity. Thankfully, new research is starting to change the establishment view of fasting.

Fasting is a varied practice that can mean time restricted-eating or one or multiple day fasts. Your fast can be clean (only water) or include up to 25% of your normal calorie intake. A doctor familiar with the subtleties and complexities of fasting will understand how to apply the practice to your circumstance.

Pick the dose of fasting that’s right for you

The dose of fasting controls the hormetic stress of fasting. People with heart disease have varying degrees of vulnerability to complications with fasting. If you are in a situation in which chest pain, arrhythmia, or heart attack is more likely to occur when stressed, you need to understand that risk.

It is rare, but chest pressure, angina pectoris, or symptoms of a heart attack could occur during fasting. You should not fast if you have frequent or recent symptoms due to coronary artery disease or heart attack. Stable coronary disease is fine for fasting, but if your doctor believes you are unstable, don’t fast.

For anyone, but especially if you have heart disease, the dose of fasting is an important consideration. It’s generally not safe for someone who had a stent placed 2 weeks ago to start a 5-day water fast. A physically active 60-year-old who feels great, sleeps well, and has been stable for months could jump into a more aggressive fasting schedule, depending on their goals.

For anyone beginning to fast, start with a lower dose of fasting and work your way up. This is a good way to be sure the stress of fasting will not be too high at the onset. Many people with heart disease have poor metabolic flexibility, and your body may not be good at turning the metabolic switch from glucose to fat to ketone burning. Symptoms like weakness, dizziness, and headache can make fasting unpleasant if you push yourself. Starting slowly is a great way to develop confidence in your ability to do longer fasts.

Monitor your blood pressure and medications

Heart medications can be affected by fasting. Some medications have better or worse absorption when taken with food and may need to be adjusted during a fast.

If you don’t have a blood pressure cuff, get one, preferably an arm cuff. Practice using it. People with normal blood pressure have little change in blood pressure when fasting unless they become dehydrated. People with high blood pressure commonly have a fall in BP. The higher your blood pressure is when the fast starts, the more it typically falls. Shorter fasts will lower overall blood pressure slowly. Longer fasts can have an immediate effect on blood pressure. Your blood pressure may creep back up after a fast, but with repetition, fasting can have a long-lasting effect on high blood pressure.

A study of 1610 people, including 313 on BP medication, who fasted 4-10 days showed that BP medication was stopped in 24% of people and was reduced in 44%. This effect occurred with just one bout of prolonged fasting.

Each person’s response to fasting is variable. Be prepared to measure your blood pressure frequently, at least daily, when fasting. Also measure your heart rate and blood pressure if you feel poorly. If you feel dizzy, particularly when standing, it could be low blood pressure. Check your blood pressure and be ready to eat salt or food—yes, to end your fast—if it’s too low. A systolic blood pressure < 90 is usually low, but if your blood pressure is 20 mm Hg lower than usual, talk to your doctor about changing your BP medication dose.

If your blood pressure falls, other medications may need to be reduced or stopped during fasting. The decision to change your medication should be made in collaboration with your doctor. It’s a good idea to make a contingency plan for how to adjust the medication if your blood pressure falls.

Be on the lookout for elevation of blood pressure during fasting as well. The stress of fasting can cause blood pressure to increase and require a change in medications.

Monitor your heart rhythm

Heart arrhythmias, including skipping, racing, or irregularities, can occur with fasting. In the long run and done safely, fasting helps to correct the causes of many types of heart arrhythmia, including atrial fibrillation. But the stress of a fast may provoke some arrhythmia, so make sure your symptoms are stable first. Changes in electrolytes can provoke arrhythmias, as can dehydration. Supplementing with magnesium, taurine, and electrolytes including sodium and potassium can reduce the symptoms of palpitations. If palpitations are severe, you need to eat something. If they persist or you get lightheaded, see your doctor right away.

You can check your heart rhythm by placing a finger on your wrist or by using a pulse oximeter, which is an easy to use and cheap tool to accurately measure your heart rate and oxygen level. To get the best reading, measure your heart rate at rest, and then check your blood pressure and heart rate after standing for 2-3 minutes. Changes in your heart rate and blood pressure when standing can detect signs of dehydration. Dehydration can cause systolic BP to fall 20 points or more and the heart rate to increase 20-30 points when standing.

A recording of your heart rhythm is even more helpful to diagnose the cause of symptoms of heart skipping or racing. Wearables devices like an Apple Watch can record an actual ECG. A Kardia device from AliveCor costs less than $100 and is another useful device to record an ECG. If your heart races or skips, count the heart rate and observe the pattern of beats. The pattern can be constant, fast, or slow. It can have periodic extra beats or missing beats. It can be continuously irregular. These patterns and the symptoms you feel with them are important to report to your doctor.

Don’t forget the salt

One of the sillier criticisms of fasting is that a lot of the weight lost during a fast is water. Of course, it is naïve to think that weight loss of a several pounds in just a few days indicates all visceral fat loss. But after you break your fast and restore the water lost during a fast, a net loss of several pounds represents predominantly visceral fat loss.

The tendency to lose water weight during fasting can lead to symptoms and problems with dehydration. Everyone needs to drink noncaloric fluids while fasting. On top of that, increase fluid intake to make up for the water contained in food. Pay attention to your thirst and hunger levels to guide you.

Salt is the go-to for relieving mild symptoms of headache, weakness, dizziness, and even hunger when fasting. For people with heart disease who often have diabetes, heart failure, kidney problems, or are on diuretic water pills, the situation with salt is trickier.

Everyone loses salt in urine when fasting, but the amount people lose varies wildly. Some people may pee out as much as 10 grams (three teaspoons) of salt per day when fasting. Taking in additional noncaloric fluid is important, but it is also important to take in adequate salt. As a rule of thumb, start with about 1 teaspoon each day and increase if you are peeing a lot, have a fall of more than 20 mm in blood pressure when you stand, or have a heart rate that is over 80 or increases more than 20 points when you stand. If you have symptoms of headache, weakness, fatigue, or dizziness you may also be dehydrated.

The tendency to lose salt with fasting has to do with how much salt is already stored in the body. Our bodies store salt in our skin. If we’re storing too much salt, we develop edema. A common source of salt overload is processed foods, which contain an extraordinarily large amount of sodium. In the typical American diet, 70-80% of salt comes from processed foods and only 5% from the saltshaker.

Another source of salt retention is metabolic dysfunction. Insulin signals the kidneys to pull salt out of the urine and back into the blood. The high insulin levels found in metabolic dysfunction, insulin resistance, metabolic syndrome, and diabetes accentuate this process. The result is salt sensitivity, a condition in which salt in your diet raises blood pressure and causes salt overload. When a salt-sensitive person fasts, the withdrawal of insulin signaling can lead to increased salt loss.

People on diuretics (water pills) should almost always stop this medication when fasting to prevent dehydration from the combination of fasting and medication induced diuresis.

While increasing water and salt intake to prevent symptoms and dehydration, remember that it is possible for people with heart problems to get too much salt. Increasing blood pressure, shortness of breath, and swelling in your legs can all be signs of too much salt. Accumulation of fluid in the lungs can cause the oxygen saturation to fall on the pulse oximeter. Most people who fast run the risk of dehydration, but some people with heart conditions may overhydrate with salt while fasting and may accumulate fluid. If you have a heart failure condition with a tendency toward fluid retention or you are taking a diuretic, plan ahead with your doctor for plans to manage your medication and hydration.

In summary

Fasting for people with heart disease offers dramatic opportunities for healing, but takes extra consideration to be done safely. If your condition is frail or unstable, do not fast. But with knowledge of the effects of fasting on your heart, people with coronary disease, hypertension, heart failure, and arrhythmia can fast safely and enjoy the healing benefits.

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