Arrhythmia, heart palpitations, ketosis, and low-carb diet

UPDATE 14/NOV: A FOLLOW ON POST ON THIS TOPIC IS HERE

I have recently tried a period of very low-carb diet, and I had some pretty unpleasant side effects in the form of palpitations bordering on an arrhythmia of the heart, and I finally got around collecting my thoughts on this.

To put this in context – palpitations are not entirely unusual for me. Funnily enough I suspected for a long time that they are at least in part related to not eating (as sometimes I got them whenever I had not eaten for a long time, and as soon as I ate something it became better).

Thanks to my recent experiment I think I now understand it better: I am pretty sure that they are related to not eating enough carbs, and more precisely to a situation where my body is in ketosis (which does make sense, as the heart can only run on carbs or on ketone bodies).

It all started maybe two weeks after I had gone low-carb paleo, with 50-100g carbs per day whilst training pretty heavily, both HIIT and weights. At one point I started having palpitations, and they were particularly heavy during periods of max heartrate (and/or when the heartrate came down to quickly in fact). So if ever you wondered why I stopped the testosterone “density” workouts (or any of the other hormone specific workouts for that matter) – the reason was simply that they did not feel right with palpitations becoming too strong, especially on high frequency overhead-pressing exercises for some strange reason.

I had read somewhere that palpitations could be related to a VLC diet (I did start a thread on Mark Sisson’s forum at the time) and I learned that a VLC diet could lead to a potassium / magnesium imbalance, so I decided to (a) eat loads of bananas, and (b) supplement K & Mg. Unfortunately to no avail.

Then along came Kurt Harris’ Paleo 2.0 article, and I learned that some Paleo folk are not that negative on starches, as long as they come from rice and/or potatoes. I decided to give it a try – so I at one meal of rice (maybe 25g of carbs), and a meal of potatoes (maybe 50g of carbs) on the next day, in addition to the carbs I would be eating anyway (fruits, vegetables, dairy, 85% chocolate). Funnily enough, the palpitations stopped pretty much immediately and did not return for the last 10days or so.

So my take-away: VLC is not for everyone – some people might just experience a carb-flu, but for some people (eg myself) things can get a bit more serious. Maybe eventually I would get over it, but I am not sure I want to try again…

PS. I still havent done any HIIT sessions as of yet – the feeling was just too unpleasant – but I suppose I will have a go at them again in the near future. So if you are waiting for the next installment of my test-drive of the hormone-specific training, I might be in a position to continue those soon. Stay tuned…
UPDATE 16/Apr: did some running today and was alright even coming down from pretty high heartrates (170+)

UPDATE 14/NOV: A FOLLOW ON POST ON THIS TOPIC IS HERE

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40 thoughts on “Arrhythmia, heart palpitations, ketosis, and low-carb diet

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  3. I am a physician and every time I try low carb diets I get palpitations that are almost immediately relieved by ingesting carbs. So I agree with you.

    • The same thing is happening to me! I became very restrictive w/ the carbs, almost no carbs and it got really bad. This is such bad news. Ive had luck with low carb diets for years. =(

  4. I have also had problems with palpitations on a vlc diet. They stopped when I when on vacation and increased my carb intake and came back when returned to strict vlc. I have a history of Aflutter that required two ablation procedures so I am apparently susceptible to arrhythmia. I think they are related to ketosis. Last night I have an extended bout that stopped immediately after loading up on some carbs. I have also had a lot of muscle cramping at night. I am definitely adding sweet potatoes and white as recommended by the Perfect Health Diet. My interest in paleo is for health and fitness not weight loss.

    • This is interesting. I understand that atrial flutter is related to (or at least can be related to) cycles in the nervous system of the (atrial portion of) the heart muscle, meaning that rather than beating regularly the muscle just contracts every time the cycle goes around (with ablations, afaik, meant to cut through this cycle). What I was trying to find out was to which extent this could be influenced by ketosis (eg nervous impulses or muscular contractions being transmitted slower or faster when using ketone bodies as fuel rather than carbs) but so far to no avail.

  5. Hey, me too. I have a long history of palpitations and attacks of atrial fibrillation, both of which improved a great deal when I went on the paleo diet 2 years ago. I’ve also experienced more symptoms when I waited too long to eat. Last year I ended up in the ER when I tried to cut down drastically on starch intake to treat another disorder. I’m fine now as long as I get 100-150 g starch per day.

    I’ve also tried to treat the heart problems with supplements. I’ve used magnesium (possibly a small effect), potassium (disaster, but that’s another story), and several others, but the only thing that’s had a clear effect is taurine. Which was a surprise, since paleo dieters get a lot of taurine through diet.

    • Andre, thanks for your comment. I hope the ER episode was rather because it was scary than because it was dangerous. 100-150g of carbs seems currently also a good target for me, maybe a bit more if I do heavy anaerobic exercises. I am also thinking of cutting it slowly – say 10g/day per week – to see whether my body can adapt better that way. This of course means that I have to go back to counting carefully…

      What was the issue with potassium? Also taurine – I always shy away from it as I thought if anything it makes arrhythmias more likely. But I guess a taurin supplement is not the same as a Red-Bull/Vodka…

      • What kind of blog engine is this? I like this nested reply function.

        Anyway, the potassium issue: The supplement (gluconate chelate) actually raised my blood potassium level out of range. I did not expect that since the amount was less than half of what I got from food every day, and the kidneys are supposed to remove excess potassium from the bloodstream. I discovered it by chance when I went to get a blood test before surgery. Which I had to postpone for 4 months, until the surgeon was satisfied that my potassium was stable and in range.

        I guess I should not have tried to supplement with potassium without some medical supervision.

        Taurine and arginine are two amino acids often used by patients to treat arrhythmias, even though AFAIK there are no good studies that demonstrate that they actually work (all I found was a couple of case studies in Medical Hypotheses).

        They are known to increase the production of NO in blood vessels (which relaxes them), and my theory is that they can help by increasing blood flow to the heart, and reducing stiffness of the pulmonary veins (where the electrical signals that cause afib often originate).

        They can also help with other … issues related to blood flow and stiffness, if you catch my drift ;-)

        At any rate, they’re cheap and probably harmless to try.

      • Thanks! Now I understand the Red-Bull/Vodka even better.

        The engine is just standard WordPress – nothing fancy (well, it is quite fancy actually, but not for the user). I believe I can even somewhere change the maximum nesting level, but I suppose 3 is sort of OK

  6. Wow! I have also had this experience for the past few days … but never realised it could be my very low carb diet that I have been dabbling in for the past few weeks, I initially thought it could be Melatonin that I was taking at night for acid reflux and so I stopped taking that, then I thought it could be that I had tappered off Paxil to zero and so started taking it again as both these could cause the palpitations, but still I get the palpitations at night before going to bed, weird, why don’t I get the in the day, kind of butterflies moving from my chest up to my throat, I’ve been trying Vonderplanitz diet of raw or scalded red meat/chicken etc and maybe that’s it with virtually no carbs so this evening had some watermelon and mash potatoes but still got the palpitations, maybe need to go on a very low protein or no protein diet? Confused.
    Gerald

    • Gerald,

      of course depending on how serious the palpitations are it might be advisable to see a health professsional. Having said this, my understanding is that it is not the high-protein portion of the diet that causes palpitations, but the low/no-carb portion: if the body has less carbs in the food than it needs to nourish the brain and the nervous system (ca 150g/day, or half that if in full ketosis) then it needs to convert protein into carbs, the protein either coming from your food, or from your muscles if not enough protein is in the food.

      This conversion is induced by a release of stress hormones, and those stress hormones can also cause palpitations – do you have sometimes similar palpitations in very stressful situations? Chances are that in this case the mechanism is as described.

      In order to address this you do not need to lower your protein intake (other than to not exceed your daily energy needs) but you need to increase your carb intake, ideally in a way that keeps blood sugar levels stable. Note that at least in my case the effect was not immediate, but the palpitations took a while to subside even after I reintroduced carbs.

      My suggestions would be to start from a Zone’ish point, ie 1/3 each for carbs/proteins/fat in terms of daily calories, and to take it from there. Carbs should be of the low GI type, rather starches than fructose/sugar (for reasons unrelated to the palpitations) and potentially avoiding grains if you subscribe to the Paleo principles (which means that rice and potatoes will become your new best friends). If the palpitations go away you can go whether you can go slowly towards a more low-carb neighbourhood. What I certainly would not do is to go from one extreme to the other, and now only eat carbs.

      Let us know how you get on
      -thor

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  8. I have suffered from palpitations for years. I had heart that some describe as “skipping beats.” 3 months ago, I was in the ER for arrhythmia. My pulse was constantly high the entire day. I went to the ER, and my pulse was 117bpm, and my BP was 197/94 (I did take my beta-blocker that day). They did a blood test and discovered my d-dimer was elevated (possible indicator of blood clot), so they did a scan of my chest, but it revealed nothing. I do not remember much, as I was given some drug there that completely relaxed me, but it did not lower my pulse any. Nothing was detected in the scan other than that my heart was at top normal, and I had mild fatty liver.

    I decided enough was enough, so I first tried some supplements. I was told that L-Taurine in 3 to 6 grams can cure palpitations, but no luck. I was told increasing magnesium would work, but no luck. I increased my potassium, but no luck again.

    I had another episode of a racing heart mixed with my heart “skipping beats,” so I decided to lose weight. I did not want to do the Protein Power (similar to Atkins diet) again, since the previous time, I had to endure a solid week of scary palpitations. I suspect that was due to my blood sugar dropping. It eventually cleared up, but it never went away. Atkins diet is great for quick weight loss, but when your desires for carbs returns then look out!!!!

    I tried the Okinawa diet this time, and I have not been having palpitations. If I do, then it is a quick flicker if anything at all. I eat rice(every other night), salmon (almost nightly). I eat tons of veggies. I eat Miso Soup, and even Shiitake mushrooms. I eat very little chicken now, as I eat more omega 3 foods. Salmon, crab meat for my mid morning snacks. I eat salads too. I sometimes eat liquid egg whites for breakfast with pinto beans (tastes great!). I eat pinto beans and black beans (good source of fiber and magnesium). I eat buckwheat noodles that are very good for those with high blood pressure. I might eat a lot of fish, but my servings of the fish are small. The fish would fit inside the palm of my hand. I tend to load up more on the greens and the beans. I eat a lot of stir fry veggies with my rice. I use a low sodium soy sauce. I would eat no more than a cup of rice. No breads, enriched flower, and NO diet pop. Sucralose and asparatame can cause palpitations. I drink water only. Keep your portions low, as I found eating too much can trigger palpitations. Just eat more smaller meals throughout the day. Never eat past 7pm. Desert is either strawberries, blueberries, raspberries, or sometimes an apple.

    I do supplement. I take vitamin C throughout the day and not once a day. I take vitamin b12, b6, folic acid for homocysteine levels. I take CoQ10 100mg. I also have been taking a new product called Fruitflow by Swanson products. It is known to work like Aspirin, but better and safer (no side effects).

    This has been working great for over a month now.

    • I should proof read before I post. I meant to say, “no enriched flour” and not “flower.” I also like to add that I am working out now too. I am doing the Power 90 (not Power 90X) to get my butt in shape. I’m in my 40′s, and am working hard at getting healthy again. It is nice to be able to go up a flight of stairs without feeling my heart pounding. I can run up the stairs now. It is nice to be able to lift things without my heart beating like crazy for hours after. My old diet was putting me in an early grave, but this new diet has had overnight results. If I sleep bad does not result in me having palpitations. I have more energy now after a bad night sleep than when I had after a good night sleep before. I lost 12 pounds on the Protein Power before in 2 weeks. This new diet resulted in 13 pounds lost in 2.5 weeks. The smart carb approach is far superior in my opinion to the high protein/low carb diet.

  9. Pingback: Arrhythmia, heart palpitations, ketosis, and low-carb diet – an update | Thor Falk

  10. I’ve had great success with the paleo diet since June 2011, it’s a lifestyle I enjoy and would recommend to anyone. Over the last month or so the ectopics I’ve had since childhood have gone through the roof forcing me to include rice and potatoes in my diet. The ectopics have completely cleared. I’m going to monitor how much starch I can get away with, though I’ll never go back to the dreaded wheat.

      • I’m currently trialling 200gms a day and everything is calm and fine, I’m going to keep at this level for another week and then see how I get on with 150gms. I’m not trying to lose weight but I don’t want to put any on.

        • Yeah, I believe 150-200g is a pretty reasonable amount – should roughly be Zone proportions (30% carbs) and keep you out of ketosis most of the time. I am targeting similar levels generally.

  11. I have had a cardiac ablation for A-fib and went on the Atkins diet. I ended up in the emergency room with A-fib and a rapid ventricular response to the tune of 180 beats a minute. I was in the ER for 6 housrs trying to get my heart rate back to normal.

  12. None of you mention how much you weigh, so it’s hard to gauge exactly what you’re doing. I am a small woman–5’3″, about 104lbs, and have been on and off low a carb diet for fibromyalgia and chronic fatigue. When I limit my carbs to 50-60/day, I may be fine for several months, but I end up with heart palpitations and A-fib at night. I’ve been in and out of halters and back and forth to cardiologists. But whenever I cheat on the diet, usually only on Saturday–with cheese, gluten free muffins and the like–the heart issues completely disappear. The only question for me is where the balance is during the week so I don’t have my already poor sleep patterns disturbed. Maybe adding beans, as mentioned above, or hummus, etc.

    • Kathleen, I’m also same height. I also had the same symptoms as you while on the paleo diet (despite eating white rice every day) and still got palpitations. It got so bad, I became withdrawn and was afraid to go out of the house, in case I fainted or died of a heart attack. And my doctor and cardiologist thought I had hypochondria and sent me to psychologist. He found that I’m not hypochondric and was anxious over my symptoms. Whenever I slipped and ate anything with wheat, grains, starchy carbs or sometimes sugar, I felt better. I’ve also had brain fog, difficulty concentrating, muscle cramps in my chest, tightness in my throat, night sweats, unable to sleep well, buzzing headaches… symptoms which I’ve NEVER experienced before. I’ve been to so many specialists, it wasn’t until recently I found the answer via Anthony Colpo’s website and Matt Stone’s website – it mentions side effects including heart problems (even death) for low carbers and many other problems paleo dieters have (make sure you eat starch and carb rich meal after reading this):

      Accelerated mineral excretion and accompanying cardiovascular complications: The accelerated sodium and potassium excretion seen on very low-carbohydrate diets has also been shown to disturb blood pressure regulation sufficient to cause postural hypotension[4]. In at least one instance, this appears to have resulted in a fatal outcome; a 2002 case report in the Southern Medical Journal reported the death of 16-year-old Rachel Huskey from Sturgeon, Missouri, who suffered a fatal cardiac arrest after commencing a ketogenic diet comprised of meat, cheese, and salads [5]. Post-mortem examination found no evidence of underlying cardiovascular disease and the toxicological report was normal, ruling out drug use. What examiners did observe was ventricular fibrillation accompanied by extremely low serum potassium and calcium levels, and possibly low magnesium levels (serum magnesium was not directly measured but can accompany low potassium levels). These findings were similar to those reported for the very low-fat and ketogenic liquid protein diets that caused a spate of deaths in the 1960s and 70s, in which low serum potassium levels were commonly noted; low magnesium and calcium levels were also reported in some of the victims[6]. Sudden cardiac death associated with deficiency of the important trace element selenium has also been noted in epileptic children following ketogenic diets[7,8].

      The May 2006 issue of the American Journal of Clinical Nutrition reported a six-week clinical trial comparing the weight loss and metabolic effects of a ketogenic diet with a non-ketogenic diet (33 versus 157 grams of carbohydrate daily, respectively). Prior to the study, all participants were screened to exclude those with diagnosed diseases. Despite this, a male subject following the ketogenic diet developed heart arrhythmias during the first week and had to be dropped from the study[9].

      Further testimony to the problems caused by the excessive mineral excretion inherent in ketogenic diets was provided by a New York Times writer, who after only three days on the initial ketogenic phase of Drs. Michael and Mary Dan Eades’ Protein Power began feeling “quite ill — dizzy, and with a pounding heart”[10]. That her situation was remedied only with “lots of beef broth and potassium pills” clearly illustrates the terribly poor nutritional quality of ketogenic diets. Potassium, after all, is abundant in the food supply and anyone eating a mixed diet containing fresh plant foods should have little trouble meeting their potassium needs.

      Ketogenic diets have been employed with epileptic patients since the 1920s, and some low-carb devotees have cited this as ‘proof’ of their safety. However, adverse effects have been widely reported among epileptics following ketogenic diets, and include cardiomyopathy, dehydration, nausea/vomiting, bruising, diarrhea, constipation, gastritis, hyperuricemia, various infectious diseases, hypoglycemia (low blood sugar), hyponatremia, hepatitis, acute pancreatitis, persistent metabolic acidosis, osteopenia, kidney stones, and severe vitamin and mineral deficiencies[19-25]. In some instances these adverse effects have proven fatal. As one doctor commented in a 2005 journal article on ketogenic diets, “tolerability and complication-related issues are the rule, not the exception … medical surveillance must be maintained throughout the entire period of dietary treatment.”[26]

  13. Although I have been paleo for about 6 months now, I’ve found no skipped beats or arrythymias from it; although I wouldn’t describe my diet as VLC, since I probably get 10-20% of my calories from carbs, mostly veggies. I definitely get arrhythmias from caffeine, though, and it doesn’t take much, about 1 can of diet Coke for a couple of days. Oddly enough, I don’t get them from 12 oz/day of cold-brewed coffee, which theoretically should give me more caffeine. So, I am keeping caffeine down to the minimum, and only consume infrequently nowadays. So, my advice to those of you who may think it’s the LC diet, is to minimize the variables and see if eliminating caffeine helps at all. I know, I know…no-brainer alert!

  14. Thanks for the great advice from all of you. I am on the Atkins Diet and all of a sudden, everytime a lay down to rest or go to sleep at night, I am woken up, by a rapid heart beat. Just had a monitor for 48 hours and they said there was nothing wrong with me. Today I decided to go on line and check things out for myself, and I found this site. Tonight I am going to add some carbs to my meal, and see if I can change things. Thanks again to all of you!

  15. Just came across this post in a Google search. Man, do I feel much better after reading this! I’m 4-days into a Primal low-carb diet (50g-75g/day), and have started noticing heart palpitations; especially last night and this morning. I did do a Primal diet a couple years ago, and strictly adhered to it for about 2 months (95% – only one or 2 cheats during that period). During that time, my weight went from 185 – 170. I was leaner, stronger, and had great energy throughout the day. Strangely enough, I never experienced a carb-flu that time, or any palpitations.

    Unfortunately, once I got back into school, I stopped eating that way, and got caught up in quick and efficient meals; not healthy options. Now I’m heavier than I have ever been (195 – 6’2″ with a body fat of 18%), and decided to give it another shot. I’ll be turning 30 this March and want to make sure I really want to stick with it, but I’m freaked out over the palpitations. Maybe I’ll give it a few more days, and if it doesn’t get better, I’ll up my carbs closer to 125-150/day.

    Thanks for the information and posts. I feel a lot better after reading this. Have a great day!

  16. I too had horrible heart palpitations every time I tried to go low carb. This last time I stuck through it and just tried to take it easy. In about a week the heart palpitations went away completely and haven’t returned. The body takes several weeks to achieve keto-adaptation and some are more sensitive in this transition period than others.

    I highly recommend the following book for more information. It explains the science behind keto-adaptation better than any other book I’ve read.

  17. My problem is slower heart rate. This morning’s resting was 57 and I know that’s not that low but for someone normally in the mid to high 70′s at rest it concerned me. The pulse has continued to be on the low side and exercise only raised it slightly then it went right back down with in a minute.. not normal for me. I am on the low carb diet to get blood sugar down (told I was in pre diabetic 2 stage) and I’m wondering if that could be causing this. Others seem to indicate higher pulse rate with the diet and I’d like to know if anyone has experienced what I’m having.

    I might add two years ago I had two stints put in due to a slight heart attack but all tests have been very normal and I’m told there was no damage to my heart so don’t know if this is of concern there or now. Feed back please.

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  20. Dunno where you read that potato and rice are Paleo because that is total BS. Do yourself a favour and read the Paleo “Bible” titled “The Paleo Diet Revised”

  21. I had the same problem with LCHF diet — got tachycardia for one week, meaning heart rate going from 60 bpm to 130 bpm in an instant, pounding some 20 seconds, and then going down as fast as it went up. Went to the doctor, all the analysis were fine, but this made me even more scared. Then I decided to eat a bunch of carbs — 5 apples, 1 orange, some syrup and so on. And the result? Active tachycardia episode stopped in 20 minutes and the palpitations haven’t returned so far (it’s been only few days now, but there seems to be a direct cause and effect relationship).

  22. So glad to find this info. My experience certainly bears out what is being said here.

    I’d hit a weight plateau with a fairly low-carb, whole foods approach, and happened across Dana Carpender’s Fat Fast Recipes book. Thought it was worth a try – no gimmicky food, just macronutrient proportions and calorie restriction to supposedly kick start your body into deep ketosis and weight loss. It’s low calorie (~1000-1200) high fat, low protein, and VLC – 18 or so grams a day. It’s a short-term process, just 3-5 days recommended. Also, she did caution that a fat fast was only recommended for people already doing Atkins maintenance level carb intake, and that you should not go from a SAD diet to a fat fast. Well, that wasn’t me, so I dove in. What’s too lose but a few pounds and possibly get my body back to better fat burning?

    Day one I felt a little low energy and hungry, but as described in her book, these were just adaption symptoms that would pass in a few days. Day two I felt worse and very hungry. Then I woke up during the night with crazy heart palpitations that wouldn’t stop to the point of feeling nauseous.. I got up and ate a little salt and whole milk yogurt and that seemed to rebalance things enough to get back to sleep. Still palps (though not as severe) in the a.m. It was time to consult Dr. Google, and here I am. Just had a piece of sprouted whole grain toast with a big smear of raw whole milk yogurt soft cheese (a more typical breakfast for me than Fat Fast’s coffee with 1/4 c heavy cream ; )

    Then I made the connection. Last year when I started on a whole foods, lower carb approach, I was doing fairly low carb. I was having intermittent palpitations, but thought it was due to a stressful work environment. Went to the doc – everything was fine (like others have reported). Eventually they stopped, just as eventually I changed my diet to include more quality carbs. After this fat fast experiment, I’m pretty sure last year’s symptoms were due to VLC.

    So even though I spent a couple of uncomfortable days, I learned something important about my body and what it feels best with. This is not the only site making the VLC-palps connection. It was repeated in mainstream and offstream blogs. Just search on low carb palpitations or some variation.

    So now I know severe carb restriction is not for me. Need to look other places to find my “sweet spot.” Makes you long for the days of small communities that ate the same food for generations and thrived on it – none of this searching and questioning what to eat to be healthy (ala Michael Pollan’s The Omnivore’s Dilema). That’s why I lean toward Sally Fallon’s Nourishing Traditions for guidance. It tries to incorporate the wisdom of those foods and food prep methods have sustained cultures for eons (post agricultural). Makes a little more intuitive sense to me that the full-Paleo theories.

    Good health to all, however you get there! And pass the sauerkraut ; )

    • I should add, I’m very healthy and had no history of palps before these two instances. So I’m pretty sure it’s VLC.

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