I started the keto diet a month ago and I’m starting to experience swollen hands, especially when I wake up in the morning. It’s extremely painful and there is a lot of mixed information on the internet. Has anyone else experienced this? What did you do to fix it and how long did it last?
Swollen hands
amwassil
(Michael - When reality fails to meet expectations, the problem is not reality.)
#2
Well, that’s something new! Not. The ‘search’ function of this forum works very well:
Jessyca1222
(Jessyca Miller)
#3
I’m pretty positive it has something do do with balancing sodium, potassium, and water. Although I’m not really sure how much of each I need to consume on a daily basis… Does anyone log their sodium and potassium intake?
ctviggen
(Bob M)
#4
That’s almost impossible to do. You’d have to measure everything, including the salt you put on food. Tough.
I’ve been LC/keto for 9 years, and still don’t know how much salt or potassium to use. If you figure it out, let me know.
I would have never though this had already been discussed. I never would have searched for this.
SomeGuy
(Joey)
#5
@Jessyca1222 Welcome to the forum and congratulations on starting out seeing how keto can work for you!
I’m sorry to hear about your morning hand swelling - all the more unsettling it must be if it’s actually painful.
Restricting carbs definitely affects water retention - significantly. That’s why many folks quickly lose a lot of weight at first, virtually all of it is water weight (not fat or muscle). And losing water has a significant effect on electrolyte balance. Which, in turn, is why it’s so important to keep sufficient salt and related elements (magnesium/potassium) to rebalance salinity.
Electrolytes are typically too low - hence the advice to get plenty of salt when starting out on keto (and to avoid the “keto flu” that can result from too little salt). But although it’s pretty hard for most folks to overdo the salt given what they’re used to (pre-keto / high carb), it is at least possible to do so.
There is an essential RANGE for electrolyes; neither too much nor too little is good, but too much is often hard to achieve because your (properly functioning) kidneys will excrete excess long before it becomes a serious problem.
QUESTION: When you add salt to your food, does it taste good? Or does it taste grossly salty? Your taste buds will provide you with an excellent first line of defense against over-salting. Many who are new to keto find it surprising how good salt suddenly tastes and almost can’t get enough. That’s a normal body signal that more is okay.
Also: Do you have any reason to believe you are suffering from any heart ailments (edema can be a sign of this) and/or kidney issues?
I’m not trying to alarm you, just to offer a little comfort (assuming you are otherwise healthy and active). Too little salt is more often the problem with water balance when “going keto” far more than too much.
Keep us posted on your progress and best wishes to get through this transition you’re experiencing. 
Jessyca1222
(Jessyca Miller)
#6
Thank you for your response. I have never had any health problems in the past. I originally started the keto diet out of necessity during my pregnancy 4 years ago. My midwife recommended it to me because I had gestational diabetes. It was great! I went my entire pregnancy without having to take anything for it simply regulated my glucose levels with diet. My hands swelled then but both my midwife and I chalked it up to a pregnancy symptom. I’m realizing now that it something much different. I haven’t experienced and lagging or nausea, no keto flu. I have not craved salt. Actually I tried to eat a few olives the other day and they did taste extremely salty. Over the last 48 hrs I’ve been kind of reducing sodium and increasing water and potassium. I greatly reduced my swelling throughout the day but it was right back in the morning. I appreciate any advice alarming or not. I want to be healthy and happy and am open to doing as much research and balancing my diet as it takes to get it right… The right way, so I’m not harming myself. The would be extremely counter productive.
SomeGuy
(Joey)
#7
I’ve often recommended this book by Dr. DiNicolantonio called “The Salt Fix” but I’ll do it again here.
He lays out easily grasped explanations as to how salt fits into broader metabolic issues, including water retention, and it’s filled with supporting citations from peer-reviewed scientific journals for further reading.
Might be of particular interest given your current and prior experience with swelling.
ctviggen
(Bob M)
#8
Personally, I would go to a doctor just to rule out that it’s not something else.
Assuming it is the keto diet, what’s the theory about what could cause this? Normally, you lose water as your insulin level goes down. Why would someone retain water only in their hands?
I did find this, which recommends increasing potassium:
This says too much salt (is there such a thing?):
Having said that about salt, I’ve backed off quite a lot of salt intake, seemingly with no ill effects. For instance, I was drinking olive or pickle juice after exercise, and I’m not doing that and haven’t been. BUT, it’s also winter. Maybe it’ll be different in summer?
My salt intake was directed more to cramps. And I’ve had none lately.
Jessyca1222
(Jessyca Miller)
#9
Wow thank you! I always love a good book to guide you in the right direction. I will definitely check this out!
Jessyca1222
(Jessyca Miller)
#10
Thank you for taking the time to look this stuff up. I was drinking pickle juice when I first started and stopped doing so in the last few days. I will check out the links you sent me!
Sounds like a throwback to those days of pregnancy 
PaulL
(You've tried everything else; why not try bacon?)
#12
Another thing to look at is how much liquid you’re drinking. As Prof. Noakes advises, the best approach is to drink to thirst. So salt to taste and drink to thirst, and that should do a lot to reduce the edema in your hands.
My signals for insufficient sodium are constipation and/or migraine headaches, and for too much sodium, it’s not diarrhoea, exactly, but stools that are clearly heading in that direction.
I often have a swelling problem in my arms, but that is because of surgical damage to my lymph nodes from an accident years ago. There is no cure for that, but I do find that lymphatic massage can be helpful. If you’re interested, there are several good videos about lymphatic massage on YouTube.
Jessyca1222
(Jessyca Miller)
#13
Strangely enough no 
for some strange reason my thing was pico de gallo. I would make a huge bowl and just eat it with a spoon. It was the damnedest thing.
Jessyca1222
(Jessyca Miller)
#14
Aside from swelling I am have no symptoms that anything is wrong which throws me off. I even donate plasma 2 times a week. I figured if there was something off with my electrolytes that plasma donation would be a huge trigger… But no. I feel great even after my donations. I have NOT been getting enough potassium from what I’ve been reading today. So I’m definitely going to change that and see if it helps.
ctviggen
(Bob M)
#15
The cheapest potassium sources are no salt or something similar:
I should say I may be getting enough potassium, because we use well water that passes though a water softener. The water softener uses potassium pellets.
SomeGuy
(Joey)
#17
Putting aside your electrolytes, have you considered whether you are growing anemic through repeated plasma donations?
Don’t mean to be alarmist, but I’ve heard that anemia and edema are linked. This may be an easier fix than you imagined. 
Jessyca1222
(Jessyca Miller)
#18
I would consider that if it hadn’t happened to me the last time I was on the keto diet. I just didn’t realize it because I was pregnant and my midwife and I just chalked it up to pregnancy symptom.
SomeGuy
(Joey)
#19
Good enough, but anemia isn’t unheard during pregnancy either. Presumably your plasma donation center performs regular blood iron tests, as you are donating 2x weekly.
lfod14
#20
Yes, but it’s never perfect unless your doing pre/post measurements of your salt shaker, I track at an anal level… but not that anal.
However, if you’ve cranked up salt, that’s probably all it is. The Salt/Potassium balance matters and so does the amount of water you’re taking in, which most people don’t even come near enough. Then many of us (like me) do hold water because of salt, Are they swollen all the time or mostly in the morning after you’ve been laying down? Easy to determine if you grab some diuretics, if you pee your hands back to normal, there’s your answer. I can very easily float 5-8lbs day to day with water retention alone if I’m not on top of it.