Arrhythmia, heart palpitations, ketosis, and low-carb diet – an update

My post “Arrhythmia, heart palpitations, ketosis, and low-carb diet” has been consistently popular since I published it back in April. It of course helps that it is generally around the top of my top posts, and people who explore the blog tend to go there first. More interestingly however I get a steady traffic from Google to this page, with keywords such as “low-carb+palpitations” or “ketosis+arrhytmia” so clearly this is an issue for a number of people.

First the good news: I am mainly fine now, and clearly (as you can see from my WOD’s) palpitations are no longer an impediment for me to exercise. I did however never get back to Roman’s hormone-focussed training that had been interrupted by those palpitations – maybe at a later stage…

I have seen a cardiologist at one point and I was wearing one of those long-term ECG boxes for a day. Funny story first: when I saw the cardiologist to discuss results she seemed very worried, as she had identified two episodes of tachycardia (around 180bpm) and she asked me whether I was alright. She was relieved when I told her that this was me doing some metcon stuff – I wanted to see whether during the de-loading phase there was a higher occurence of palpitations than usual – there wasnt.

In any case she could identify what exactly were those palpitations that I’d feel every couple of minutes: those were extra systoles coming from the atrium. She then explained me that those are actually rather normal and nothing to worry about, and that in particular they are often a reaction to stress. Now I was reasonably stress free in my personal life at this point in time, there were nevertheless a couple of stressors

  • I had increased my squat from 0 to 125kg; in this process however I had developed some permanent pain in the hip flexors, probably because of overuse / inflexibility after more than a decade of desk-bound work
  • I was going to the gym pretty much every day, alternating heavy lifts (well, sort of heavy; they were heavy for me anyway) and metcons
  • I had tendonitis in my right elbow that I could shake for a couple of months
  • I had started eating paleo, and slowly but surely drifted into the 50g of carbs per day territory
  • I had got myself a cold

So I decided at this point that I’d lay a bit low. Also, luckily enough Paleo 2.0 had just “come out”, and my take-away was that some starchy food (potatoes, rice) is actually OK if one does not go overboard on it, so this is what I did. The impact was actually quite impressive: whilst not going entirely away, adding starches made a big difference how I felt (the fact that my cold went away might have also contributed though….)

So my final take-away: eating low-carb is a stressor for the body (I have read this somewhere by the way – something about adrenalin cortisol being released so that protein can be converted into glucose that is needed for the brain, even in ketosis). Some people deal better with it, some worse. Probably this can either because of different stress levels induced, or a different stress-tolerance level, which is an important distinction, as the latter sounds to be a recipe for long-term disaster: even if LC eating seems to be fine for a couple of months or even years it might catch up eventually. For me in any case the stress induced by LC eating leads to palpitations, so I am not trying to make sure that I have enough carbs. I am no longer counting, but I estimate that my daily carb intake is between 100-200g, a lot of it from fruit an vegetables, the preferable from rice or potatoes, and I have to admit unfortunately also a fair amount of from baguette with or without cheese (when in Athens….).

7 thoughts on “Arrhythmia, heart palpitations, ketosis, and low-carb diet – an update

  1. Thanks man, I took up paleo to sort out chronic fatigue syndrome, and while i saw alot of symptoms go away I started to have more palpitations. I’m going to try eating more carbs now. I think i went overboard on the restriction.

      • Well, I have started eating one carby meal, a bit of potato or rice each day and I’m seeing improvement. I’ve also started taking high dose magnesium, which may be the deciding factor though. I’d say the biggets problen with the Paleo lifestyle is that it usually misses out a couple of pretty important nutrients almost entirely.

      • Any chance you could expand on this? I have read various things about Magnesium for example – most people seem to say that Mg deficiency doesnt really exist, and it is more the K/Mg ratio that matters anyway. What other micronutrients do Paleo v2.0(ers) – ie not the low carb type – miss?

        • well, honestly, I’m not totally up on my micronutrients. I think they’re on the ball with the calcium and magnesium balance though. My symptoms are at their worst when I consume dairy products (which have a 10 to 1 K/Mg balance, while the ideal is 4/1). The problem is that outright saying that is all that matters is wrong. I’ve been on the diet and consumed no real calcium, but still had horrific problems with my magnesium.

          I think another misunderstanding is that people eat too much fruit. Which is always said to be good for us, but aparently up to 30% of the population have an intolerance to fructose that can cause some pretty bad symptoms.

          I’ve also noticed people’s blood pressure gets a bit too low sometimes aswell, and that is because of just slightly too little salt consumed. I used to add salt to my food all the time before going paleo and found that when i stopped my blood pressure got too low.

  2. The most important mineral to supplement on VLC is sodium, an additional 2-3 gm/day more than what you already consume in food, for a total of 5 gm/day. It is not optional, it is required. And if you engage in high-intensity exercise, you need even more than that. Ignore this advice and enjoy your heart palpitations, arrythmia, pounding heart, sky-rocketing stress hormones, fatigue, headache, insomnia, etc. Stephen Phinney has written extensively about sodium requirements on VLC (in addition to K and Mg requirements) and what may happen if you don’t get enough. I too developed heart palpitations 3 months after starting high-intensity weight training on VLC. I too got sucked into the advice that I needed to raise carbs or reduce the exercise intensity (or both), which indeed did work. But then all my other metabolic and inflammatory problems returned, which defeated the whole point of going VLC and exercising intensely to begin with. Heart palpitations or diabetes… hmmm, thinking, thinking. Not happy with that choice. Finally read Art and Science of Low Carbohydrate Living and Art and Science of Low Carbohydrate Performance. Kicked myself for not reading them both when first published. Clinical pearls in there. I added the sodium as recommended and gradually the heart palpitations disappeared. I can now eat VLC, exercise intensely, feel great, look great, and ignore the nonsense about requiring starchy styrofoam in my diet. A poorly-formulated low-carb diet is a stressor on the body, particularly if lacking in sodium; a well-forumulated low-carb diet is not. Read Stephen Phinney. He is the greatest.

  3. I was on keto for a few weeks and basically abused my body. I was eating less than 20g of carbs per day and ended up in the ER with Atrial Flutter for 14 hours. My bpm was 140 or so for that time and eventually it returned to normal. I had low magnesium levels. I attribute this episode in part to very low carbs plus a bunch of stress and 2 hours exercise per day. I have not had any further episodes since eating normally.

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