Heart palpitations finally got the better of me

(Toni) #1

I’m so disappointed, I had to go back to eating carbs today as the heart palpitations I have been having for the last 5 weeks finally got too much.
I started keto this time on August 1st, and did ok for the first 7 days, then the palpitations started and I have had them every day since. No other sypmptoms such as headache or dizziness, just the heart, and only when resting/sleeping.
I’ve tried every dose and combination of electrolytes, potassium, magnesium, salt etc and nothing works.
My doctor has run every test Full bloods, all perfect, ECG and echocardiogram, all fine, however on my 24 hour Holter monitor test it showed all the paplpitations, and they were ectopics and Afib, though only minor. He wasn’t interested in discussing my diet just gave me a script for beta blockers and aspirin, of which I refuse to take.

I know this is being caused by the diet, so I went to a dietician last week, who specialises in keto, she asked me to take more magnesium 600mg a day. I did feel slightly better for a few days but then straight back to where I was. So I dosed up on salt and potassium, made it worse.
I finally now have had to give up, but I am so disappointed. I don’t know how to start over. For now I am eating a chocolate bar to drown my sorrows.
Has anyone had similar problems, and if so what did you end up doing?

My ‘stats’, 53yo, 5’2", healthy, 63kg, need to lose 5kg. Blood pressure fine. I have been intermittent fasting daily for the last 3 years usually 18:6, and A couple of years ago I did several 3 day fasts that were hard, but doable.

I’M EDITING MY POST TO ADD MORE DETAILS:
I started keto about 6 weeks ago, I have done it before in my life with no problems, it was many (10-15) years ago (before it was popular), and I would have called it dirty keto. At the time I was a runner and very fit.
Not so fit now!
This time my first week I was attempting “vegan keto” so I was not eating enough protein and probably about 30-40gm carbs a day so I would probably not have been in ketosis that first week, but not had enough carbs for my body to run on. That’s when the palpitations began on day 8. I went to the doctor who ran all the tests.

I decided to add fish and eggs into the mix, fish 3 times a week, 4 eggs a week, and got rid of the sweet potato and corn.
After 3 weeks I still wasn’t low enough on my carbs so I went down to 20gm a day and added more meat and added dairy back in. Still no change.

At this stage 3 weeks in I am 20g carbs, 60g protein, 100g fat - tracking and achieving this daily.

I must say that I did not really lose much weight, about half a kilo in the whole 6 weeks, and I did not feel any better, still sluggish, tired etc as I had been feeling for the last few years.
However I did not feel any more unwell, no apparent keto flu or headaches etc. only the palpitations which is why I didn’t think electrolytes were a big issue, but was still adding as much salt as I could stomach on my food, with the odd 1/2 tsp salt and 1/2 tsp low salt in a glass of water to add some.
I tried to eat plenty of green veg and good healthy fats, butter and coconut oil the whole time. I want the benefit of as many whole foods or veg as I can have in my 20gm carbs.

I used keto pee strips the first 2 weeks, and it was mostly dark purple, then I purchased a blood monitor and it ranged between 0.6 and 1.6 most days, usually around 0.9-1.1.

I drank 2.5-3 litres of water daily, I do not drink coffee or tea so there is no caffeine. Water fasting till noon when I eat my first meal.

I take a big list of supplements every second day, DHA, ALA, curcumin,NAC, B12, Iron, and several more.
For the last week I upped the Magnesium from 100mg (Cabots mag, a mix of 4 types mostly citrate) a day, to 600 or 800mg of Magnesium amino acid chelate (Mag bisglycinate).
One day I took 2 doses of 500mg potassium and it made the palpitations significantly worse, it’s what really scared me and made me stop the diet.

Since I started eating carbs yesterday my weight has not gone up, though I expected it would with some water retention, so I don’t think I have been dehydrated.

(Polly) #2

Do you have the same problems with your heart on a three day fast as you do with keto? If not then it is probably not the ketosis which is causing the problem. However, you may be able to lose the weight you want to shed through fasting.

This describes ADF https://youtu.be/kaOpTqpZuiM

There is an ADF group on this forum ADF club and those people may be able to help you.

(Toni) #3

NO i never had it on the 3 day fasts, but it did take 7 days to start on the regular keto, so it might not be a good comparison. I am going to eat carbs for a week and see if it goes away, so then I will be certain.

#4

Hi Toni,

Welcome.

Heart palpitations and atrial fibrillation? Yep, me too.

It would be helpful and interesting to see how you structured your version of the ketogenic diet. Then the very smart people in the forums can get you some good, solid advice.

For the moment you have me here. And I see Polly has joined as well. Cool. My first suggestion is to wait and see what a number of people advise.

The 7 day timescale is very interesting. For me, it’s about 14 days after I clean up my keto eating act. My best explanation is that it relates to the diuresis or naturesis (as Dr. Phinney describes it) created by the dietary adjustment. The flushing of the body and retained fluids as glycogen is depleted takes away electrolytes as well.

Let’s, for a moment, have a look at the chocolate bar you are munching on, since it’s in you hand and now in our minds. It’s OK to eat it. Chocolate has a high stearic acid component from the cocoa bean fats, that’s good. Chocolate, especially dark chocolate has magnesium content. Unfortunately the magnesium may not be available to your body because chocolate also contains oxalic acid which binds up the magnesium Chocolate will create a release of ‘happy’ (but momentary) brain chemicals. Chocolate is amazing stuff.

OK. Heart palpitations and rhythm abnormalities are often electrolyte based. Occasionally there are cases of infection illness with viruses or bacteria that can create heart tissue damage and result in similar symptoms. But you make no mention of having been ill. It’s worth mentioning though due to COVID being prevalent. We’ll keep that worm can closed for the moment.

The dietitian, I think, is on the right track. There may be quite a few electrolytes at play, including sodium and potassium, but magnesium acts as an elemental calcium channel blocker. That means having adequate magnesium regulates the excitation effects of calcium on muscle cells. If heart muscle cells get to electrically excited we get palpitations and rhythm changes.

600mg of elemental magnesium per day increase is a good start. It’s the magnesium part that is important. But some practitioners also look closely at what makes the ‘salt’ or the chelation in the magnesium preparation. For example, I take magnesium citrate because I want the citrate molecule as well. Whereas others may seek an amino acid to fix a deficiency and that is the part of the supplement description that follows the word magnesium.

These days I take 600 mg of magnesium divided into a 300mg morning dose and 300mg evening dose because I have been experimenting for 3 years (not constantly, but when episodes happen) to find what works for me when palpitations occur. That’s my baseline. When I get palpitations, and there are many different triggers, I add to that baseline with more supplements, breathing exercises and sometimes medication (that beta-blocker you mentioned). And I fix them. I have been keto regularly, by all means not perfect, for almost 6 years for its positive health benefits. In the past 3 years I have had about 10 or so atrial fibrillation episodes. The early episodes required medical assistance because they are scary.

If you are overweight (only slightly it seems), then the best thing to reduce the re-occurrence of heart palpitations and atrial fibrillation is to lose weight. that is according to my specialist cardiologist. Smart guy but doesn’t look that healthy. I’m biased, but I reckon the best way to lose weight is using nutritional ketosis in the dietary mix. In your situation you have many options to get to your goal. So, keto, may not be the way is an option. That said, many will say keto is for health, not for weight loss. The weight loss being a side effect like the heart palpitations.

There is lots of information on the forum (link below) because ketogenic eating commonly unmasks underlying problems that can result in the heart palpitations symptoms. You see I use the term ‘unmask’. And I use it purposefully. These episodes provide the opportunity to deep dive into one’s health issues. The cause can be quite a bit of work to identify, but the path has been shown to us.
https://www.ketogenicforums.com/search?q=Heart%20palpitations

I could make this way too long to read but we have a start. How have you structured your ketogenic eating?

@VirginiaEdie

(Stuart Young) #5

Man, well that’s a kick in the nuts hey?!

I am not posting with any great advice here, the post above by Franko seems a great place to start, and I know others will be able to pitch in too.

I just wanted to post that the complete opposite happened to me. I have had heart arrhythmia since I was 21. As time has gone on, it has gotten worse. Mild symptoms after I eat, much worse at night when trying to sleep.

Giving up caffeine helped slightly. Traditional dieting helped slightly too, but that was not sustainable. I was resigned to living with it.

Upon starting Keto, it was almost immediate. My symptoms stopped. The second night, the silence from my heart was deafening. Instead of the usual pounding I could hear, that I had grown accustomed to for 20 years, there was silence. It freaked me out!

I am now having the best sleep of my life thanks to Keto.

Franko mentioned Keto has probably unmasked a problem. I wouldn’t say he is far wrong.

For me, I know my way of eating all my life has impacted on my heart health, and Keto is allowing some healing to begin.

I would have to say in your case keto probably diagnosed the problem, and is not the cause. I know this may appear a bias view, being in the keto forum, but perhaps eating carbs (chocolate bar) will only mask a problem you have. If it does go away with eating carbs, I would still endeavour to find out what is going on

Good luck!

(Toni) #6

Thanks for your post I will certainly look into it more. I am just off to bed but I’ll post my food and macros etc tomorrow. It’s been about 8 hours since my chocolate bar and a few more sweet treats today and the palpitations have completely disappeared already.
A cardiologist wrote the report on my echo cardiogram and my heart is apparently on perfect working order. I definitely think it’s an electrolyte imbalance, I just tried everything and couldn’t find the right ratio. Maybe starting from scratch will help.

(Toni) #7

It’s funny how we are all so different. I’ve never had a palpitation in my life so it’s been very strange for me. But I was so determined that I could figure it out, to admit defeat is hard. They have stopped all together now that I’m eating carbs again. I’m certain that my heart is fine, all the tests have been done and I have all the cardiologists reports. I posted here because I knew I would get some great info from this group on how to look at proceeding. Tomorrow I’ll start afresh with maybe a different approach…

#8

Hi Toni, I have had the heart palpitations on and off since starting keto on Feb. 1 this year. Interestingly, many of the worrisome symptoms that started in my first month or two have greatly lessened or disappeared over time. I certainly focused on magnesium supplementation at the start, and it helped a lot. But lately, I’m noticing that I’m not paying much attention to my supplements (i.e., forgetting to take them), and in spite of that, the palpitations (and nighttime cramps) are mostly gone.

I’m not one of the deeply knowledgable folks on this forum, but just wanted to comment that my experience suggests the body could take months to adapt to this different WOE. Good luck to you.

(Bacon is a many-splendoured thing) #9

I would suspect a poor electrolyte balance, in particular low magnesium and possibly potassium. And (I always point this out), these two minerals (and calcium) are better-regulated by the body when we keep our salt intake in the proper range (10-15 g/day). Remember that we need to work a bit to keep up our salt once we go keto, because a high carb intake prevents the kidneys from excreting as much sodium as they are supposed to.

The mechanisms that regulate these minerals are all inter-linked, and sodium intake is the one that is easiest to manipulate, so that’s the place to start. Get the right amount of salt, drink plenty of liquid (enough to satisfy your thirst), and then re-evaluate. Sometimes getting salt in the right range is all it takes; other times we still need to supplement.

(Edith) #10

Hi Toni,

I went through a lot of troubleshooting for heart palpitations. The link below became my journal of all the things I tried to stop the palpitations. The list includes food intolerances, histamine intolerance, and finally magnesium. You may want to read through the thread.

I didn’t think it could be magnesium at first because I had been supplementing with magnesium for years. But, on keto, I was eating a lot of oxalate containing foods: berries, nuts, greens, dark chocolate. Oxalate binds with calcium and magnesium and prevents those minerals from getting absorbed by the body. I do believe, and I have no proof, that eating too much oxalate caused me to become deficient in magnesium. I had to supplement 800-900 mg of Mg a day to get the palpitations to stop. I now eat a very low oxalate diet and I am back down to 400 mg of Mg a day.

Something to be aware of: I went to the ER twice because my heart palpitations were so bad they scared me. Both times my electrolyte levels were fine (potassium slightly low once). It is very difficult to tell magnesium deficiency from a blood test. So, just because a blood test shows you have good magnesium levels, you could still be deficient.

Something else to consider since you are petite. I am 5’3" and I’m 54 years old. Keto is high fat. Fat doesn’t actually contain that many nutrients. When 60-80% of your calories comes from fat, that does not leave a lot of calories to get all the vitamins and minerals you need. As a petite person, every bite you eat on keto needs to be as nutritious as possible. Fat bombs in a way are like eating empty carbs except they are made out of fat.

https://www.ketogenicforums.com/t/heart-palpitations-and-magnesium/51759

If you are interested in knowing more about oxalates, please do a search on that topic. There were too many little tidbits here and there for me to include a link. This is just my journey. Yours could be different, but I hope my journey may give you some ideas.

Edit: One last thing: I needed to supplement an extra 1.5 teaspoons of salt a day on keto. I am carnivore now and my sodium need has gone down a bit, but I still need to supplement in addition to what’s in my food. I know I need extra salt when I either get muscle aches and cramps and sometimes heart palpitations.

(Toni) #11

thank you Wendy, that helps, it certainly looks like magnesium is the problem I think I will have to experiment with it more.

(Toni) #12

Virginia thank you so much, I read through that entire post on your palpitations and I honestly felt like I was almost reading my own story, except at the moment mine is shorter! I have always been such a healthy person, I used to run half marathons and all. I hate the idea of taking any kind of drugs. My resting heart rate is in the 40"s and I get my palpitations when I’m resting or lying around so I am not sure if that contributes.

I think the part about the oxalates/histamines is really interesting. My dietitian did mention those briefly when I saw her, but it was my first appointment so we didn’t get into it much. She was certain that magnesium was the issue. SO I started on 600-800mg a day of mag citrate that she gave me. It really did seem to help and they reduced by less than half in severity. Then I decided to take 2 500mg doses of potassium one day to see if that helped even more, and well the palpitations came on worse than ever. So I didn’t do that again but added more salt instead, only 1tsp to maybe it wasn’t enough. I just go to the point where I felt is was all a bit out of control so I had to take a break.
Interestingly the same as you whenever I took in a few extra carbs in a day the palpitations reduced, and since yesterday when I had chocolate and icecream they have disappeared altogether.

(Toni) #13

Paul thank you. I suspect you are right about the salt, I was putting it on everything I ate and trying to chug some down but ultimately probably still not enough. I think the potatssium I was adding was throwing me all out of balance. I plan to start again soon after a break and will be more diligent with my measurements :slight_smile:

(Toni) #14

FrankoBear I’ve amended my original post to add more detail, if you have a moment to take a look I would appreciate any more insight you may have. At this point from the comments below it definitely looks like magnessium, I may just need to play around more with that.

#15

I’ve never noticed benefits from 18:6 or fasting for more than 24 hours. I’ve only noticed benefits from OMAD(23:1).

If carbs eliminate the symptoms. This tells me a lack of IGF-1.

It would be interesting and helpful for others if you could have a IGF-1 test.

https://kidshealth.org/en/parents/somatomedin-test.html

Niacin 500mg split in half and half taken twice daily is what eliminated my palpitations because niacin increases growth hormone and subsequently IGF-1. However my heart issues are due to covid.

(Toni) #16

That’s interesting I’ll read up on it.
Yes I have tried OMAD and 24 hour fasting regimes.
Personally for me the idea that the Keto approach stops you feeling hungry all the time is the thing I hope to achieve.
I feel my entire life I’ve been food deprived and hungry, I could literally eat all day, be full and still eat. I’ve controlled it my whole life, but I just want a solution where I dont constantly feel hungry or think of food. On OMAD I was starving for about 20 hours a day.

(Michael - When reality fails to meet expectations, the problem is not reality.) #17

@tonib

#18

Many people confuse stress for hunger, needing to poop for hunger, air pollution for hunger and other oxidative stresses for hunger.

#19

Hi Toni. I reckon @VirginiaEdie Edith is the goal kicker for you. I’m so glad she joined us.

I’ll take this in sections as I am working on a project that needs to be done by tomorrow night.

The potassium dose and worsening heart palpitations is the part I’d like to tackle.

1000mg of potassium. I’ll go and search the standard dose… 1000mEq is the maximum dose and that is about 3900mg. So it doesn’t look like an overdose. But that is an average person dose. Most of these averages have been worked out on testing males. If you are replete in potassium from dietary sources adding an additional dose may have some effect. Sometimes it is laxative. Other times it is on the heart.

I know, from clinical practice, a patient’s heart can stop if a potassium dose is not well mixed into intravenous fluids and a higher concentration bolus runs in. Potassium is something to be very careful with, in my non-medical opinion. (I am not a doctor. I’m just interested in health).
https://www.mayoclinic.org/drugs-supplements/potassium-supplement-oral-route-parenteral-route/proper-use/drg-20070753

The other bit of information you provided is a resting heart rate in the 40s. That is very fit or possibly a bit slow? It’s likely fitness :slight_smile: But it’s at the low end of normal.

So, here is how I see the potassium episode played out. You have a low heart rate as a baseline. That varies with the palpitations. So you started supplementing extra electrolytes. That may have slowed the rate again (improvement noted).

However, if the heart rate is slow, to you it’s normal, and you have a normal beat (normal pQRST complex on ECG - electrocardiogram), then to achieve that slow rate there is usually an extended delay between the T wave and the next p wave for the next beat (the blips on the heart monitor screen).

It is in that extended period between beats where extra beats (ectopic beats) are likely to occur. Depending on which area of the heart contracts they, the extra ectopic beats, have different names e.g. PVC - premature ventricular contraction. We experience that phase of arrhythmia as palpitations as the beats vary in strength and frequency. Eventually those extra beats may flip the heart into fibrillation, usually atrial fibrillation (AF), where the contractions of the heart chambers lose rhythm and start pumping really fast.

So, if your baseline heart rate is ‘normal’ in the 40’s you will likely have to pay close attention to your electrolytes. And potassium’s effect of slowing the heart rate even further may make things worse, as you experienced.

From what you report the cardiologist says your heart structure and function is fine, so you have had the work up there. Did they comment on your observation of your normal expected heart rate? Not sure what tests you went through but you wore the monitor. Did they do any imaging?

Summary: Potassium dosing slows the heart. With an already slow heart rate the heart may respond with palpitations and extra beats, if the heart is slowed too much with a potassium dose. That may have been what you experienced on the day 2 doses of 500mg potassium was supplemented.

Thanks for the brain exercise. remember this is just a forum of ordinary people with a special interest. My suppositions may not reflect the truth of the matter. They are thought explorations. There is more to say and explore but I have to finish that work project.

I’m glad the few added carbs helped directly. Carbohydrate levels and women is another can of worms. By adding a few more carbs it probably helped your kidneys regulate the electrolytes by a slight increase in circulating insulin. But then there is some interesting notes by @anon81060937 about IGF1 - Insulin-like Growth Factor. Methinks insulin is very insulin like. Gah, I’ve got to stop now :slight_smile:

(Toni) #20

You made me laugh. And I’m so happy about what you wrote. First yes I think Edith has had the same issues as I do, I’m following her story closely and adjusting my routine accordingly. Second thanks for the explanation on potassium and heart rate. Although I am no longer all that fit, I think the 20 years of running in my 30’s and 40’s gave me the strong heart and low resting heart rate. Yes I have ectopics and short periods of afib exactly as you mentioned. Specifically on the report it mentions SVE’s including triplets, couplets and isolated beats. Up to 145bpm. As well as sinus rhythm. Minimum heart rate 42.

Even though I’ve been eating carbs all day some palpitations have come back so that’s a concern.

I have found a doctor that advocates low carb so I am going to see him thus week, with more knowledge so I can hopefully get some good advice from him. This group is proving invaluable, I appreciate the time you took to respond. :blush: