New here and need some help troubleshooting

[David_Stilley]

I’ve been trying to not take too much salt because I am still eating daily,

What does this have to do with it? You need salt, eating or not. If you eat sodium rich foods you don’t need to eat that much extra salt. I honestly don’t measure but I Salt my food pretty well, more than most probably. And if I feel punk, Salt is my first go to to see if it helps. Usually it does.

[henrymandelbrot]

If you eat sodium rich foods you don’t need to eat that much extra salt.

Like you say, if I’m eating, I’m assuming I’m getting some electrolytes that way. So I try to not add too much supplemental salt with water. But it very well could be that I’m not getting enough in my food to start with.

[David_Stilley]

Extra sodium is lost through urination, you don’t need to be cautious about too much salt unless it’s a lot too much, then you get diarrhea.

[henrymandelbrot]

People seem to agree that most of us are magnesium deficient no matter what style of diet we are eating. It seems safe to go up to 1000mg daily of magnesium for a while, and back off to 500 or so.

I’ve read that too much potassium can cause immediate and serious heart problems. Usually only if taken as a supplement, not in food. I’ll need to look more carefully into what exactly is “too much”

Too much sodium can raise blood pressure. I’ve certainly seen my BP go way up after some meals. So I might be sensitive to this. But my typical pressure is so low that it probably isn’t much of a worry.

I once did a cleanse that involved drinking a quart of water with a tablespoon of salt all within 5 minutes every morning. I can attest to the effects of too much salt all at once.

Thanks for all the feedback! I increased my magnesium last night and felt better within an hour. I’ll keep increasing that plus potassium and sodium and report back on the results in a few days.

[BlueViolet]

This intermittent pounding HR doesn’t sound cardiac in origin to me based upon the neg diagnostics you report.

It sounds more like a systemic reaction to something; the cardiac response is just that: a response. The heart itself functions properly and is sound.

A transient inflammatory response, perhaps?

Too much sodium can raise blood pressure.

Sodium can cause fluid rentention; THAT (increased fluid volume in the vessels) is what actually causes elevated BP. High carb intake can also cause fluid retention in some individuals; it does so markedly in my case whereas high sodium does not.

My blood pressure and heart rate can be pretty much anything when I’m feeling the forceful heartbeat.

Because the symptom’s source isn’t cardiac nor vascular in nature.

Sounds benign and transitory; could be a food reaction as in ingesting something to which you have a sensitivity or actual allergy.

108/73

112/84

137/88

These are hardly “spikes” and are normal fluctuations

[henrymandelbrot]

Thank you for adding that. I’m fairly confident that wheat products cause negative responses in me. Many beers (especially my favorite IPAs) often cause me to go into a sneezing fit in addition to making me feel fatigued.

But while doing keto, I’ve been avoiding wheat and everything made with it except for about once a week when I eat some bun with a burger or low carb tortillas with burritos. The symptoms described in the OP are present for days at a time. So I don’t think it’s that specific known thing.

I also suspect tomatoes may be a problem for me based on past reactions when eating SAD. But again, I’ve been eating nothing with tomato in it except about once a week when I make keto tika masala or butter chicken. Those meals don’t seem to cause me any change for me at this time.

The “spikes” may not be all that dramatic considering cardiologist (on youtube anyway) talk about people getting up over 200/90. Certainly I’m not worried about 137/88 taken by itself. But I guess I don’t know what normal fluctuations should be when I’m hydrated, but haven’t eaten in a couple hours, and am just siting at a desk. Should Diastolic rise by 12 points over 10 minutes for no clear and obvious reason?

Being able to measure things like BP or glucose is probably causing a lot of people to get worried about fluctuations unnecessarily because the measurement is far easier than understanding what’s ok and when. I personally feel like my lack of knowledge in this area has caused me anxiety over it, coupled with the heart palpitations.

I do think what I’ve been experiencing is food related, not a “mechanical” problem with my heart or vascular system. But if so, is it something I’m eating? Or something I’m not eating enough of?

[DeeCS]

I’ve read that too much potassium can cause immediate and serious heart problems. Usually only if taken as a supplement, not in food. I’ll need to look more carefully into what exactly is “too much”

You may find this discussion of potassium of interest. I did extensive research and posted my findings as well as my n=1.

Let's Talk About Potassium Supplements

I had quit taking potassium supplements because so many posts I read made me feel like I would die if I took even a little too much. Several days ago when I first started getting at least 4 g of salt every day to deal with orthostatic hypotension, I quit supplementing with potassium. I hadn’t been sleeping well up til then, but slept really well right from the first day of adequate sodium, then in the past couple of days, started not being able to sleep. Last night was the worst and my calf an…

[BlueViolet]

Should Diastolic rise by 12 points over 10 minutes for no clear and obvious reason?

This is so no bigs, trust me.

my lack of knowledge in this area has caused me anxiety over it, coupled with the heart palpitations.

Ya. You sound a tad hypochondriacal
I have anxiety though with many triggers so I’m not saying that meanly

What you described is NOT a “palpitation”; it sounds more like vessel expansion (the walls of the vessels expanding with each heart contraction). You said your actual HR remains steady duing the episodes.

is it something I’m eating? Or something I’m not eating enough of?

Honestly it doesn’t sound diet related; I just had occasion in another thread to say “correlation needn’t indicate causation”.

It may be a sensitivity to something you ingest, thence triggering a transient inflammatory response, but unless you have other symptoms to report, this one event occurring alone doesn’t indicate anything worrisome; your doc must agree as you don’t mention him recommending any further diagnostics.

[henrymandelbrot]

The posts on potassium supplements was indeed a very good read!

I feel a lot more confident taking more Potassium than I have been so far. My kidneys are fine, so I don’t think I need to worry about it at all. I’ll stay well under 5g anyway.

[henrymandelbrot]

I might be a tad hypochondriacal.

I definitely have a tad of OCD. Allow that to exercise itself on personal health and you get a problem with fixation and maybe some self fulfillment. I’m aware of it and try to stay rational and use ranges when looking at numbers. Kind of like staying in between the lines while driving. It doesn’t matter too much how close you are to the center of your lane as long as you stay between the lines when you need to.

It’s hard to find clear guidelines on this stuff. I’m sure it’s out there, but there is so much conflicting advice out there too. Bodies are complex. Fortunately they are also pretty tolerant within ranges.

I’ve been feeling quite good today for the first time in about 4 days. My forceful heartbeat got quiet over the hour after I took some magnesium drops and has stayed in what I would call a normal state since then.

I’ve had my normal coffee, fats, and water with salts today. But I increased the salts and switched from Magnesium chloride to sulfate. Also took a single 200mg Mag Glycinate. My plan is to try to build up Magnesium stores at 800mg intake for a couple weeks and then cut back to about 400mg supplementation a day to sustain.

[David_Stilley]

I’ve been feeling quite good today for the first time in about 4 days.

Glad to hear it Henry. Stay well.

[BlueViolet]

I definitely have a tad of OCD.

I have more than a tad
I’s been very handy for keto; my rigid adherence to routines.

a problem with fixation

Erm…ya.
#relatableaf

[henrymandelbrot]

It’s been a few days, so I figured I’d follow up for others who might find the thread later and be having the same issues.

I’ve increased my intake of Potassium, Magnesium, and Sodium by adding them as granules/powder to 1.5 liters of water in the following quantities per day.

• Potassium Chloride 1/2t = 3.4g = 1700mg Elemental Potassium = ~42% of 4000mg Daily recommendation
• Magnesium Sulfate 1/2t = 3.0g = 300mg Elemental Magnesium = ~75% of 400mg Daily recommendation)
• Sodium Chloride 1/4t = 1.8g = 700mg Elemental Sodium = ~30% of 2300mg Daily recommendation
• Sodium Bicarbonate 1/2t = 1.1g = 315mg Elemental Sodium = ~14% of 2300mg Daily recommendation

I also drink several glasses of plain water through the day in addition to eating low carb foods. I don’t eat much processed food. I don’t salt my foods excessively.

I’ve been feeling much better for the last few days. I have still occasionally had a somewhat forceful heartbeat, but it was more short lived and seemed to go away after drinking some extra water, sometimes with potassium.

It seems that sometimes when this is happening, my gut is bloated as though the liquids I’ve been taking in are not being absorbed for some reason. I haven’t figured that out yet. Other times it seems that dehydration is the more likely cause.

The last couple times I’ve had a late night small amount of scotch (~1.5 oz) a couple hours before bedtime, I’ve ended up with my legs threatening to cramp in the early morning. Getting up and drinking water with magnesium citrate drops seems to help with that.

So I haven’t totally nailed down causation for this. And it’s not totally gone. But the focus on getting enough water, and adding electrolytes and magnesium seems to be helping.

I find it frustrating that eating like I have been is resulting in what seems like a careful balancing act with electrolytes and dehydration. I know not all people have issues like this. So I’m probably not doing something right with my food choices. I continue to learn.

What’s nice is that I’ve lost 30 lbs in the last few months and am very close to my ideal weight now. My old clothing that used to fit well is actually a bit too loose at this point since I’ve been 20+ lbs overweight for the last 8 or more years until now.

It’s possible that some of these problems are just a result of consuming this much of my body fat. It’s also possible that I’m simply getting fluctuating blood glucose levels due to the need to be shifting to glycogen stores frequently. I’m probably not very efficient at that yet.

It’s all pretty complicated. I wouldn’t be focused on it so much if I weren’t having problems. But I don’t want to go back to eating the way I was, so I’m trying to find a better diet than what I’m doing now, still not going back.

Fortunately the salty water is helping a lot for now.

Notes:

I measured out the salts using a level 1/8th teaspoon. It’s a precise enough method for this, but numbers do differ from what I found online for weights of the salts. I’m using Pink Salt which is mostly regular Sodium Chloride, but does have other minerals. The Sodium Bicarbonate (baking soda) is to alkalize the water to ease digestion.

This salt water mixture is recommended for people doing water fasts. I’m using roughly 2/3rd the salts of what I’ve seen for recipes out there since I’m doing it to augment my low carb foods.

My most recent blood test (taken after about 2 months of a mostly keto diet) showed all 3 of these electrolytes to have serum levels in a normal range. But my Vit D was very close to the low end of normal and I’ve had levels under normal in the past, requiring prescription supplimentation. My calcium was on the high end of normal. I typically eat a lot of cheese, so it’s easy for me to get calcium.

The forceful heartbeat can also be caused by anemia resulting from low iron or low b12.

It can also be cause by low blood pressure, low blood sugar, dehydration, and anxiety. Caffeine, nicotine, alcohol are also causes.

Some people have palpitations after heavy meals rich in carbohydrates, sugar, or fat. Sometimes, eating foods with a lot of monosodium glutamate (MSG), nitrates, or sodium can bring them on, too. Food sensitivities can also cause them.

I used to get them after a meal with a lot of bread. Sometimes after dinner while reclined for a long time, no matter what I ate.

[Momof5]

It is great that you figured out what works for you Henry =). I wish you all the best in your continuing Keto journey =).

[David_Stilley]

The last couple times I’ve had a late night small amount of scotch (~1.5 oz) a couple hours before bedtime, I’ve ended up with my legs threatening to cramp in the early morning. Getting up and drinking water with magnesium citrate drops seems to help with that.

I would try drinking a big glass of water with the drops before going to bed. You may not get the cramps at all. A little before bedtime is the best time to take magnesium anyways for better sleep.

[henrymandelbrot]

UPDATE:

Since posting this 16 days ago I can say drinking more water with mag drops before bed does indeed seem to help with the cramping feeling. Legs feel more relaxed all night. And I have had less feeling like they might cramp. Thanks @David_Stilley for the suggestion.

But I have not been able to get rid of the intermittent forceful pulse. I thought it was gone when I went several days with no symptoms. Then it came back for no reason I can figure out.

It then went away again, and came back again. I’ve been keeping a log of every time I eat something, drink something, go the bathroom, and sleep. I record what I ate, every suppliment I take, how much, and when. Yet there’s still no consistant bit of info that stands out as correlating to when I start feeling this.

I’ve also started scoring it on 0 - 10 for how bad it is. 0 means “I don’t feel anything abnormal with my hear at all” and 10 would be “take me to the ER right now” but I haven’t gone over 7 yet thankfully.

Last Thursday I called my doctor to tell them I was having this symptom pretty bad and would like to see someone while it’s going on. What I got instead was a 10 minute talk with a nurse who had me take my blood pressure and then a call back from her saying the doctor wants me to get a holter monitor test again. I did one 5 years earlier for some other very different intermittent feeling. It was totally negative for problems then, and it this time the only things they noticed were a couple episodes of light fluttering that were of no concern.

Of course when I got to the place to get the holter monitor the day after my call, I wasn’t feeling much of the forceful pulse anymore. And the two days I had it on, I felt pretty much ok the whole time other than a pretty strong change when I went up a flight of stairs a few times.

Normally a single flight of stairs does nothing to me. I have a 14% body fat. I’m in my mid 40s. When I do cardio I can get up to 170 BPM before it feels at all bad. I can keep it around 150 to 160 for 20+ minutes. But when I’m feeling this forceful pulse, squating to pet a dog makes my heart pound. Walking one flight of stairs does. Cleaning a litter box does.

When this is happening, I can sit in a chair or lay down and it will just continue to pound. The rate may go lower unless I get anxious about it, but the pounding will keep going even when I’m totally still for 10 minutes.

I got a Basic Metabolic panel a couple weeks ago and all my numbers were very much in the normal range. I was feeling pretty normal at the time of that blood draw. Then yesterday I was feeling pretty horible after the forceful pulse started roughly 36 hours earlier. Two nights of poor sleep and it wasn’t going away during the day either.

So I called the doctor again and said “I’d like to see someone today while this is happening so I don’t have to go to the ER instead. It’s not an emergency. I just keep wasting time going to doctors days after the symptoms subside”

That got more attention and they made me an appointment with a different doc for an hour after the call. The nurse did blood pressure and pulse. The results were higher than my normal, but still just below the point where “They recommend treatment”.

This doctor took more time to talk with me, listened to heart and lungs etc. In the end his suggestion was along the lines of “You may just be focusing on it too much, and anxiety may be exacerbating it”. He had no interest in the fact that I’ve been in ketosis for about 3 months and have lost 36 lbs since starting eating this way 4 months earlier. He had no interest in my questions about electrolytes since my readings were all in their “normal” ranges. He dismissed the idea that it might be dehydration saying “Have you ever been dehydrated? You would know if you are dehydrated. First signal is you get thirsty.” Then he went on to tell me that “God designed our bodies so that we don’t hear or feel our muscles or heartbeat”. And at that point I decided that continued attempts at rational conversation were pointless.

The visit ended with him suggesting I do a three day trial of taking anti-anxiety meds for all three days to see if that keeps the forceful pulse at bay. If it does, talk to a psychiatrist instead because my heart is doign fine. Then I went and got another blood draw for Basic Metabolic Panel.

So I started that 3 day trial yesterday. I didn’t take any electrolytes the whole day. I just ate normal low carb foods, some of which had a lot of sodium. My forceful pulse (FP) started getting worse even with the anti-anxiety med in system since morning. I took another dose of it in the evening. I didn’t feel anxious about anything. But the FP kept getting stronger. I ate a huge helping of cauliflower “Mac and Cheese” from the perfectketo recipe and the FP continued to get worse. There was 1/2 t regular sea salt in what I ate in addition to whatever was in the cheeses and cauliflower. I drank a couple glasses of water with and after this meal.

I took a nap for about 3 hours and woke with the FP stronger than before. I’d rate it at a 6 or 7 out of 10. At that point I got a glass of water and added 1/4 t of Potassium Chloride and drank that down. Within 30 minutes the FP feeling was down to roughly 1 or 2.

I got my test results back today and found that my sodium was higher than normal a couple weeks ago when I was feeling fine. All my other scores were fairly normal for me. This last test from yesterday when I wasn’t feeling right came back with my sodium having droped from the top of the normal range to the bottom of the normal range. Chloride was also way down and at the bottom of the range.

The night before that blood draw I drank down some extra sodium and a lot of water and didn’t feel any better. But I urinated a lot more than normal too. I’m guessing there was something going on with sodium/potassium balance and my system was flushing too much.

I’d think maybe my glucose is too low. But my test showed 98. My past tests were all in the 90s also. I got a keto breath meter yesterday and it read 6 once and 7 the next few times through the day, right before bed, and after waking. It says 7 is “Very high, deep ketosis”.

So, I’m still thinking this is electrolyte related, but the numbers in tests have failed to support this. And I can’t get a consistant response to taking the salts with water. Sometimes I feel better in 15 to 30 minutes, other times worse. Sometimes I try sodium, sometimes potassium, sometimes both, sometimes with magnesium. Can’t find any consistency.

Now I’m going to go get a calcium score CT scan and probably find that it too is perfectly healthy… Yet somehow I keep randomly feeling like crap in a very specific way.

[PetaMarie]

I’m sorry you’re having so much trouble. I know it is frustrating and scary when you have heart worries. When I started keto over a year ago I sort of did it all wrong and felt pretty crumby right out of the gates. In an attempt to feel better I began to supplement with potassium, magnesium and got very liberal with the salt. Within a few days I felt like my heart was beating too forcefully. It was annoying and worrying. I messed around with a few things and, for me, stopping the potassium supplement was what helped me.

I continued to take magnesium and heavily salt my food. I stayed hydrated. I eventually ran out of magnesium and stopped that as well. I went through a leg cramp phase but figured out that if I stayed hydrated (but not overly hydrated) and got enough salt, they went away. Drinking pickle juice during (usually at night) helped within 30 minutes.

Anyway, maybe you need to cut it all out, the supplements and stick with staying hydrated and getting the appropriate amount of salt (sodium and chloride).

My brother has major heart fear issues due to some palpitations and ER visits in the past. He won’t exercise because even feeling a high heart rate spins him into an anxiety attack, which makes things even worse. I do think your doc was being insensitive, however, heart health fear is a thing that can become a real phobia so while you work it out try to do your best to tell yourself that this is temporary and that you WILL get it sorted. (We always go over the signs of heart attack and he never has them but it helps to go through the check list when he’s having a scare.)

Best wishes and congratulations on the weight loss!

[henrymandelbrot]

Thank you for the kind words and your experience with something similar. I’m mostly over the anxiety around it since all the tests I’ve been having done with my heart are coming back with very healthy reviews. At this point I just want to get the issue sorted out so I can confidently walk up a single set of stairs and lift something heavy without feeling like I’m going to pass out. And I’d like to be able to fall asleep without the feeling like someone is moving the bed under me rhythmically.

I imagine it’s probably not healthy in the long term to have the heart acting this way either. So I’m hoping to find whatever balance is needed.

The weight loss is one thing the doctors have been universally congratulatory on. I think maybe they are getting some training on how to respond to that one. They all sound the same, careful to not say anything at all bad about weight loss no matter how it came about, even if they don’t like my LDL shooting up, and my complaints about strange heart behavior.

The advice I’m getting from both doctors so far has been “You should ease up on the diet and liberalize what you are eating”. Maybe I will at some point transition to more Paleo or Mediterranean style diet. But I’m determined to give nutritional ketosis a try for a bit longer as long as I’m not facing any health issues that doctors agree are serious. Since they seem to only agree with each other that it’s in my head, I think I’m OK so far!

[henrymandelbrot]

Update

I’ve now had various blood tests for electrolytes, thyroid, and other things, all indicating that everything is in normal ranges.

I’ve had an EKG indicating normal sinus rhythm etc.

I’ve worn a holter monitor for 48 hours with the same results even though I was experiencing some periods of mild forceful heartbeat. What irregularities they noted were all within typical ranges that most people experience daily.

I’ve had a CT scan for calcium and got a 0 score, which indicated no arterial plaque at all found.

I’ve had an echo cardiogram which came back with no abnormalities at all in valve operation or anything else.

I even took anti-anxiety meds for 3 days straight as a test the doctor recommended to see if it’s just anxiety triggering the issue. On the 3rd day my heart started acting up and got worse into the night despite still being under the influence of the meds.

In summary, the doctors have run all the heart and blood tests they think are at all relevant to proper heart function and my heart is in perfect order from what they can tell. They kept suggesting it might just be anxiety. So I did their 3 day test and still had the heart issue start up and get bad.

It’s not my heart, or anxiety. So what is it?

Everything I can find points to electrolyte balance combined with hydration as the likely culprit.

So I tested my responses to various intakes of sodium, magnesium, calcium, and potassium. When I was doing the 3 day anxiety trial, I didn’t take any supplemental salt or the others. On day 3 my heart started to freak out.

I drank down some salt, potassium chloride, and magnesium drops, and it got better slowly. I drank more, it got more better.

I got some books from the library including “The art and science of low carbohydrate performance”, “Keto Clarity”, and “Magnificent Magnesium”. The advice in all of them was to increase magnesium. So I made 400mg a day my standard. The cramping I was getting sometimes hasn’t happened since.

The keto books suggested increasing salt intake to well past the 2300mg RDA sodium in all cases unless there are blood pressure issues or other doctor indicated reasons not to. Sodium has to stay in a pretty narrow range in blood and adequate intake helps ensure that when the water content of tissue is decreased as it is in ketosis.

Nothing suggested taking potassium supplements. But they did suggest eating potassium rich foods. There might have been mention of using the 50/50 blend of “Lite Salt” which is half potassium chloride if one thinks they aren’t getting enough food sourced potassium. But while potassium deficiency is fairly common, it’s not usually necessary to take it in concentrated form, and could be dangerous to the gut (ulcers) and muscle function, including heart.

So I stopped taking potassium chloride mixed with water and increased my regular salt intake by drinking broth, adding more to my foods, and adding some to my water. I’ve increased my salt by about 3/4t a day over my prior normal which was always pretty low when I do my own cooking.

In the last 10 days I’ve had some short periods where my heart started beating forcefully, but I drank a tall glass of water with 1/4t salt, and it went away.

My n=1 seems to indicate consistently that my problem has been low sodium. Maybe there has been some interaction with potassium, and probably my magnesium has been sub-optimal too. But the low sodium seems to be solely responsible for my feeling of a forceful heartbeat.

My assessment of the whole thing is that going keto decreased the water available in my system to reserve sodium so that my body could take from it to stay in the necessary tight range of blood concentration. Low serum sodium led to the heavy feeling heartbeats. Drinking more water didn’t help because low serum sodium just instructed kidneys to flush the water, taking some sodium with it as a side effect, making the problem worse.

Drinking saltwater did however help because it allowed quick correction to serum sodium levels. Keeping it high enough all the time allows the cells to maintain higher potassium levels since sodium and potassium have to be in balance outside and inside cells respectively.

So, making sure I’m adding salt to my diet often has been what has worked for me for the last 10+ days.

New problem, I can’t stay asleep more than 6 hours…

[David_Stilley]

Awesome you got that one figured out, Salt is the “master” mineral that balances all the others.

New problem, I can’t stay asleep more than 6 hours…

Welcome to the club! Many people start sleeping less on KETO. If you really feel like you need more sleep try taking your magnesium an hour before bed if you’re not already doing it. KETO and IF got me more in tune with circadian rhythms and I wake right before dawn everyday 95% of the time. Even if I go to bed at midnight. I haven’t been a long restful sleeper for a long time prior to eating ketogenic, so I have had some general improvement from before. All I can advise you from the standpoint of an insomniac is don’t let it stress you. Lying very still and concentrating on deep breathing and relaxing is better than tossing and turning. And if it goes on long get up and utilize your energy. You’re body might be needing less down time sleeping if the quality deep sleep is there. Whatever happens stressing about not enough sleep compounds any real effects from lack of sleep. You’re body will catch up if things get too out of whack. Something that has helped me is no eating for many hours before bed, in my case usually I try to cut off at 3:00pm. That’s extreme but I have my reasons for it. I sleep much better without the digestive process going, completely empty. If you’re actually having trouble getting to sleep that’s another issue. I feel good with six hours most of the time, occasionally I get seven.