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Athletes, AF, Anticoagulants, Statins, Peanuts, and Dishwashers

Here is an update on my recent writing.

Athletes and AF:

I was honored to be invited back to the Western AF symposium in Park City, Utah. Last year, I presented on social media. This year, Dr. Nassir Marrouche (University of Utah) asked me to tackle the topic of atrial fibrillation in athletes. This is no small matter.

In the process of putting together the 20-minute talk, I wrote an essay as a guide. In Athletes and AF: Connecting the Lifestyle Dots, I review the evidence, mechanisms, and treatment considerations of the endurance athlete with AF.

My argument in the talk and essay is that AF happens for a reason–even in athletes. We are at an inflection point in the way we think about AF. I made the case that the exercise-AF narrative fits with this new thinking.

AF and anticoagulant drugs: 

In The Gambling Game: Clot vs Bleeding, I address the issue of preventing stroke in patients with atrial fibrillation. The stimulus for this essay was a new study from Sweden that reported lower than expected stroke risk in non-treated AF patients with only one risk factor. (CHADS-VASC-1).

This is important data because knowing the risk of stroke without treatment informs the decision on whether to take an anticoagulant drug. It is definitively not a yes or no call. The tradeoff is always the same: anticoagulant drugs lower the risk of stroke but increase the risk of bleeding. You need stats (and a good adviser–doctor) to make the best choice. And it is your choice.

Statin drugs:

In the post, Statins in Primary Prevention: Welcome to the Gray Zone, I discuss the issue of predicting the future–at least, as it pertains to cardiovascular events. A recent study suggested that standard CV risk calculators overestimate the chance of a future heart event. That is big news because it affects the controversial decision to use pills to prevent heart disease.

For instance, statin drugs, like any medical or surgical treatment, force a patient and doctor to make a gamble. Does the benefit of the drug—a lower chance of a heart attack or stroke—outweigh the risks and costs of the drug?

Recently, guideline writers suggest statin benefit turns to the good when 10-year risk is greater than 7.5%. My post deals with the problem of knowing your future risk, and the wide swath of gray area in the use of statin drugs for primary prevention.

Peanuts, Fats, Dishwashers and Health Advice:

Being wrong about health topics is like the new normal.

For years, children’s health experts scared parents about peanuts. Don’t let your baby near peanut products until they were three. Now it looks like the opposite is true.

For years, nutritional experts warned us that eating fat would make us fat–and give us heart disease. That, too, looks wrong.

And in recent years, experts have created a systemic phobia of all things dirty. Bacteria and viruses are to be feared. Makers of hand sanitizers have cheered the new aversion. Now we learn that leaving a little bacteria on your dishes and utensils (and eating fermented foods) may help prevent allergies. Simply…you might be too clean.

How is this happening? How can experts have been so wrong about such basic things?

You can read the entire post here: Peanuts and More: When Health Advice Is Wrong

Thanks for reading.


I hope to post the Athletes and AF PowerPoint soon.

5 replies on “Athletes, AF, Anticoagulants, Statins, Peanuts, and Dishwashers”


Your posts on AF, EP, decision making etc. are always wonderful and informative.

Your posts (and thought leadership) on hubris are pretty uniquely you. There aren’t many people saying that. Of all the posts you’ve written, the ones I find myself reflecting on are when you challenge our culture of always knowing what’s right.

I don’t know how a clinically busy EP could write a book but you should write a book about this.

The Hubris is a cultural sickness in medicine. It’s insanity and erodes trust when we’re wrong.

Thanks again.


(Time to feed my kids rotten, fatty, fermented peanut snacks without washing my hands!!!)

I second the book vote. People need a voice that is honest and can explain complex matters accurately and clearly.

Thanks Dr. M for your open minded thinking on AF. I am a 54 male and had my first episode January 2014. I have also been a lifelong aerobic exerciser and competitor from the the time I was 16 -28. (Bicycle racing, a few marathons and many triathlons). May 2014 and Oct 2014 were very bad months for my AF, averaging 1-2 episodes a week. Also, at this time my relationship challenges were extreme. Coincidence? I think not. The heart feels. (see I have worked hard to improve my marriage, let go of riding over twenty miles, and used other holistic tools to heal my system and heart. Dring the last 4 months, I have had one short AF episode. Coincidence? The heart feels and heals. Thanks again for pushing for the truth in the mainstream and against the tide!

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