Hight HeartRate, palpitations, low HRV and fibrillations when on keto


(Titus) #1

Hi everyone, I’m 60 and I’m new to the forum, but not new to keto. By the end of May I restarted keto, and within a week of less than 20g carbs, I reached a ketosis state. But I started to feel more and more tired, my resting HR measured with Oura became about 10bpm higher than normal, and my HRV measured with EliteHRV was very low 30. I said it’s the adaptation, I increased my salt intake and I continued to train moderately. After 2 days I felt my heart pounding, and mild fibrillations, the hear was beating weird. I got so scared, but these days I don’t want to go to the hospital. I stoped keto but I didn’t get into any deserts, or beer, stopped even my training. I started to feel better, the fibrillations stopped, and HR was normal. 23 Days ago I started Keto again, and this time after only 3-4 day I Was I ketosis. Gradually my HR started to increase again, and I met the same issues. I took potassium, lots of magnesium, more salt, selenium and the fibrillations stopped, but my heart is still pounding with HR 10-20 more bpm than normal, and I am like that extremely tired for the last almost 3 weeks, without seeing any change in better, but even my HR is higher and higher.
I am desperate, don’t know what to, I don’t call my doctor because he’ll tell me I’m crazy, that I should stop the keto, otherwise I’ll die. And of course I don’t want to. I can’t train, I can’t jog properly.
I’m 60, 155lb/5-11, with 20% fat, BMI 21. As you can see I don’t do keto to lose weight, but I felt good mentally and with no inflammation when I was on keto last year for about 4-5 months and I lost 27lb
I started having doubts about the safety of keto, I don’t know what to do, I’m totally disappointed, And there is no way to find a keto oriented cardiologist to tell me what can I try.
Guys, please any advice would be greatly appreciated.
Thank you very much


20g Carbs
(Alec) #2

Titus
Sounds very troubling. I don’t have solutions, just thoughts and opinions.

  1. First up, if I were in your position, I would stop doing keto right now, and go low carb. I would then slowly over a number of weeks, drive the carbs lower and then see when and what symptoms you get and at what carb level. You seem adept at self measurement: make yourself an experiment of 1.
  2. I don’t think you should worry too much about higher HRs: I have certainly had higher HRs while on keto, and I have heard others experiencing the same.
  3. However, your low HRV, your heart palpitations and extreme tiredness are, IMHO, concerning symptoms that suggest some immediate action is required, hence suggestion 1.
  4. I think you should go to your dr to have the discussion about what you have experienced, and see if they have any suggestions about what to do or not do. Yes, they MAY tell you to stop being crazy, BUT keto is gaining some momentum now… doctors do have patients that are openly on keto, and some are gaining some experience of treating patients on keto. I recognise that your dr may well simply tell you to go back to higher carb living, which is not what you want. But, important: you do not have to do what your dr says about diet. Doctors work for us, not the other way round. But given your heart symptoms, I think it is worth your dr knowing this. You may have an underlying condition that currently only shows up on keto, but which without treatment may get worse. Maybe as an outcome aim to get a CAC scan to find whether you have arterial calcification? That is always healthy to know in any case, why not use this issue to get that scan?

I hope you find good solutions for you. Best of luck.
Cheers
Alec


(Bacon is a many-splendoured thing) #3

Are you drinking enough? One possibility is that you are somewhat hypovolaemic.


(Alec) #4

Paul, that’s today’s new word… googling now… :joy:


(Alec) #5

Hypovolemia , also known as volume depletion or volume contraction , is a state of decreased intravascular volume.[1] This may be due to either a loss of both salt and water or a decrease in blood volume.[2][3] Hypovolemia refers to the loss of extracellular fluid and should not be confused with dehydration.[4] Dehydration refers to excessive total body water loss that results in cellular hypertonicity (a relatively substantial loss of fluid within individual cells).

Hypovolemia is caused by a variety of events, but these can be simplified into two categories: those that are associated with kidney function and those that are not.[5] The signs and symptoms of hypovolemia worsen as the amount of fluid lost increases.[6] Immediately or shortly after mild fluid loss, one may experience headache, fatigue, weakness, dizziness or thirst (as in blood transfusion, diarrhea, vomiting). Untreated hypovolemia or excessive and rapid losses of volume may lead to hypovolemic shock.[7] Signs and symptoms of hypovolemic shock include increased heart rate, low blood pressure, pale or cold skin, and altered mental status. When these signs are seen, immediate action should be taken to restore the lost volume.


(Titus) #6

Yes 2.25l per day for my 155lb. I think it’s OK


(Titus) #7

Thanks


(Bunny) #8

I had to weigh in on this because I experienced the heart palpitations myself after doing strict keto for two and half years at 20 grams of carbohydrates and not being diabetic, I experienced heart palpitations ”…paraesthesia (numbness), muscle weakness…” mentioned below; and I think it is very very important topic to discuss a little deeper when it comes to sodium and potassium balances and imbalances on a ketogenic diet? AND HAVING A MORE KEEN SENSE OF AWARENESS ABOUT THAT WHEN ON A KETOGENIC DIET?

We must have a little awareness related to what Alec is pointing out above by The American Heart Associations guidelines:

Hyperkalemia (High Potassium)

How does hyperkalemia affect the body?

Potassium is a mineral that is crucial for normal cell function in the body, including heart muscle cells. The body gets potassium through foods.

The right level of potassium is key. The kidneys are primarily responsible for maintaining the body’s total potassium content by balancing potassium intake with potassium excretion. If intake of potassium far outweighs the kidneys’ ability to remove it, or if kidney function decreases, there can be too much potassium and hyperkalemia may occur.

Potassium and sodium concentrations play a crucial role in electric signal functioning of the heart’s middle thick muscle layer, known as the myocardium. An above normal level of potassium can interfere with proper electric signals in that muscle layer and lead to different types of heart arrhythmias.

How is it diagnosed?

It can be difficult to diagnose hyperkalemia. Often there are no symptoms. When there are, symptoms may include nausea; a slow, weak or irregular pulse; irritability, paraesthesia (numbness), muscle weakness, diarrhea, abdominal cramping or sudden collapse if the heartbeat slows or stops.

In many cases, hyperkalemia diagnosis must rely on clinical information such as a history of kidney failure or the use of medicines known to cause hyperkalemia.

Laboratory data and electrocardiographic changes can also be used along with clinical information to reach a diagnosis. For most people, their potassium level should be between 3.5 and 5.0 millimoles per liter (mmol/L). Hyperkalemia is a potassium level of greater than 5.5. Patients with hyperkalemia may have a normal electrocardiogram or only subtle changes.

Can it be prevented?

Dietary changes can help prevent and treat high potassium levels. Talk to your doctor to understand any risk you might have for hyperkalemia. Your doctor may recommend foods that you may need to limit or avoid. These may include:

  • asparagus, avocados, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, cooked spinach
  • oranges and orange juice, nectarines, kiwifruit, bananas, cantaloupe, honeydew, prunes and raisins or other dried fruit.

If you are on a low-salt diet, avoid taking salt substitutes.

How is hyperkalemia treated?

If your potassium level is very high, or if there are dangerous indications such as changes in an electrocardiogram, emergency treatment is needed. That may involve supplying calcium to the body through an IV to treat the effects on muscles and the heart or administering glucose and insulin through an IV to decrease potassium levels long enough to correct the cause. There are also medicines that help remove the potassium from your intestines and in some cases, a diuretic may be given.

Emergency treatment may also include kidney dialysis if kidney function is deteriorating; medication to help remove potassium from the intestines before absorption; sodium bicarbonate if acidosis is the cause; and water pills, or diuretics.

A doctor may also advise stopping or reducing potassium supplements and stopping or changing the doses of certain medicines for heart disease and high blood pressure. Always follow your health provider’s instructions about taking or stopping medicines. …” …More


(Titus) #9

Bunny, Thanks for the reply, but you didn’t tell me how fixed your problem? Did you stop keto or you found a way to counteract the kyperK. Also I don’t know what to believe, according to the web during keto adaptation, the potassium is low, not high, and hypoK also causes heart arrhythmias. See below.
In the first few weeks, your body loses a significant amount of water. As this is processed through the kidneys this can then affect the electrolyte balance. Sodium is often the first electrolyte to be lost. Since potassium is closely related to sodium and because the kidneys control the levels, a drop-in potassium can also be experienced.


#10

Magnesium is antiarrhythmic but too much can cause cardiac arrest.


#11

Hi Titus. Here is an anecdotal experience.

I developed atrial fibrillation on the ketogenic diet. Atrial fibrillation starts with heart arrhythmia and extra beats but then the heart can switch into an excited state with heart rates, in my case, between 120 - 180 bpm for many hours. It’s exhausting, scary and causes chest pain.

It was not a perfect ketogenic diet. But I was generating blood ketones and was very low carb. So the diet is not to blame. The fault is in the implementation.

I suspect an imperfect ketogenic diet has the potential to become a depletion diet over time. For example over months or years.

My story has twists and turns. 3 years after the first AF episode, I still eat a low carb ketogenic diet. The key part of my experience with dietary induced heart palpitations is that I learned about it. In my case I accepted some medical advice, refused some medical advice, tried but eventually abandoned drug treatments by manipulating my version of the keto WOE. In my case the key was electrolytes and, in particular, magnesium. But as you have noted electrolytes are interconnected, so it is a mix and a general persistent increased intake of sodium, calcium, magnesium, zinc et al that has resolved the problem. My cardiologist wanted to burn away part of my heart muscle. That provided enough motivation to work things out physiologically and as an n=1.

These days I supplement zinc and magnesium citrate daily and enjoy Himalayan pink salt on my keto foods.

The twist in the tale is that AF returned after a period of remission when I tried a carnivore diet. I was still supplementing the mineral micronutrients and enjoying my salt. But something happens about 2 weeks into a strict carnivore diet for me and my heart rate rises. I have repeated the carnivore experiment 3 times with the same result of heart arrhythmia and palpitations each time.

So something else is happening there as the supplements are still adhered to. Something seems to be gobbling up my heart regulating mineral micronutrients when I change from animal-based keto to carnivore. The main suspected cause is oxalate release. But many don’t believe it exists.

I return to ketogenic eating with fermented vegetables, some keto vegetables, seaweed and coffee and the problem goes away.

My blood test tracking has always been healthy on keto for over 5 years. But I wonder if I have a rare or unique kidney quirk that effects my mineral micronutrients and subsequently these regulating affects on my heart rate.

At this time I’m still dodging and baffling the cardiologist.


#12

@FrankoBear
Have you tried one meal a day and only eating after feeling the high growth hormone levels… hulk feeling?


#13

Hi Titus. My story is similar to that of FrankoBear. I have been eating this way for just under 2 years now. Some months into this WOE I began to have a racing heart on and off and high blood pressure. The cardiologist wasn’t worried for some reason, and was even glad I was on the Keto WOE as he said he had seen all of his patients who eat this way improve their heart issues greatly, but he didn’t know much to help me. He was just sure I was on the right path.

I did my own research and increased my daily potassium, magnesium and salt consumption daily, tracking what I was consuming from food and supplements and the problem went away very quickly. I have found that as long as I get between 3000 mg and 4000 mg potassium spread throughout my day, 600 mg magnesium glycinate (avoid mag. oxide), and eat plenty of salt I don’t have any problems. Keeping those three things in the right amounts has solved my issue.

Cronometer is my app of choice to track the nutrients I consume from my food and supplements. It helps me know where I am low. I can be low a few days in a row in something, but it catches up if I don’t bring my levels up.

One thing about Keto is that we don’t seem to hang on to our electrolytes as well because we don’t retain water. I know some people don’t seem to need supplementation, but I certainly do. I hope you find your answer!


(Titus) #14

I also do time restricted eating with 18h fast every day for 2 years, but I can’t tell feel the growth hormone


(Titus) #15

Hi, and thanks for the reply. After suffering and worrying for the last 3 weeks, and after long debating with myself and with wife, I decided to stop the restricted keto yesterday, but to continue with a moderate LC diet with 50-100g carbs per day, to see how I feel. I don’t have diabetes, I’m not overweight, so for me keto is not a must. Just a few hours after eating some carbs, I started feeling better, my heart stopped pounding like crazy in my chest, last night sleep was much better, my morning HRV was much improved. I saw your recommendations for electrolytes, and it is very possible that they would work for me as well, but I consider 4000mg of potassium per day a huge dose, and the danger for Hyperkalemia it’s worrisome as well. As I said I also increased my electrolytes with supplements but I sticked to the daily recommended, 100mg for potassium for example. Yes taking 400g of magnesium glycinate stopped the very worrying fibrillation, when my heart was beating like a 3 cylinder engine, but I was not able to find a way to stop the palpitations (heart beating very strong and fast) even at rest, for no reason. My sleep HR was 70, and normally is 58. I enjoy doing physical exercise, but in that condition it was impossible and I don’t want to die from a heart attack. I know most people are Ok in ketosis, but I am different for some reason, don’t know why, maybe my kidneys have a problem. I still don’t understand how come last year during my 5 months ketosis period I didn’t have this.


(Titus) #16

Hi and thanks for your reply. I think you are right, I think there’s something related to my kidneys and how they deal with electrolytes. As I mentioned in my other post I stopped the almost 0 carbs WOE yesterday, and just after a few hours I feel normal again. I don’t know, I have the feeling that the body needs a little bit of carbs too, and the total depletion is not good for the heart. I’m not diabetic, my BP is perfect 111/60, my BMI is 21, for me keto is not a must, and I don’t intend to die from a heart attack, so I decided to continue with moderate LC WOE 50-100g per day.
I took this decision because the eventuality of a major heart issues like AF (as you had) is extremely scary for me. My few episodes of mild arrhythmia on top of the continuous heart palpitations day and night even at rest, gave me a very good image of this eventuality.

I think there are advantages even for a moderate LC diet combined with a time restricted eating.

Thanks again