The ketogenic (keto) diet has gained immense popularity as a weight loss strategy and for its potential health benefits. The keto diet is a low carb eating plan, like the Atkins Diet that was popular in the 1990s. However, like any significant dietary change, it can come with side effects. One such side effect that some individuals experience is heart palpitations. If you’ve recently started a ketogenic diet and you’re experiencing heart palpitations, you’re not alone. This article delves into the causes of heart palpitations on a keto diet and provides guidance on how to manage them.
What are Heart Palpitations?
Heart palpitations, or increased heart rate, can be a common side effect of transitioning from the carb-heavy standard American diet to a diet plan that is higher in fat, moderate in protein, and very low-carb. Heart palpitations can feel like a racing heart or fluttering feeling in the heart. While disconcerting, they are often harmless. There are several possible causes of heart palpitations, including stress, intense exercise, caffeine, hormonal conditions, and medications. There are also causes that could be of medical concern, especially if you have increased risk factors for cardiovascular disease (including heart disease), such as diabetes, obesity, high cholesterol levels, or high blood pressure. A condition called atrial fibrillation can also be a cause.
The Keto Diet and the "Keto Flu"
In the context of a keto diet, heart palpitations are one of the many symptoms of the “keto flu,” which includes a variety of unpleasant side effects that may occur while your body is transitioning from using glucose (sugar/carbs) for energy to using fat for energy. Other common side effects include constipation, bad breath, muscle cramps (especially leg cramps), and fatigue.
When you eat less than 50 grams of carbohydrates a day, your body eventually runs out of fuel (blood sugar) that you can use quickly. This usually takes 3 to 4 days. Next, you will start breaking down protein and fat for energy, which can cause you to lose weight. People frequently use the ketogenic diet to lose weight, but it can help control certain medical conditions, such as epilepsy. People with type 1 diabetes are not recommended this diet, because it increases the risk of producing ketoacidosis.
Common Causes of Heart Palpitations on Keto
When transitioning to keto, heart palpitations are typically due to dehydration or a mineral deficiency. Here's why:
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Dehydration
When you cut way back on your carbohydrate intake on a low-carb diet, your body produces less insulin and uses up its glycogen stores. As we mentioned, when you cut your carb intake from lots of carbs to nearly no carbs, you produce less insulin (insulin processes the glucose in carbs). When this happens, your body excretes more water with the glycogen (which is why you tend to lose water weight quickly on keto).
Electrolyte Imbalance
The primary three electrolytes that can be affected when transitioning to keto are sodium, potassium, and magnesium. Sodium, potassium, and magnesium are all essential minerals for your heart.
According to The Merck Manual for Consumers, “Some minerals-especially the macrominerals (minerals the body needs in relatively large amounts)-are important as electrolytes. Electrolytes are minerals that carry an electric charge when they are dissolved in a liquid such as blood. What do these minerals do? A lot!
- Sodium: Sodium is an essential mineral found in the intracellular fluid of cells. Sodium helps your cells to maintain homeostasis, regulates fluids, balances other electrolytes, regulates blood pressure, and is crucial for the electrical charge of muscle and nerve cells, by transporting nutrients through the cell membranes. So, obviously it’s important to get enough salt. But not all salt is created equal.
- Potassium: Potassium is an essential mineral that many of us are actually very deficient in, and it’s a big “heart health” mineral. This mineral is crucial for the excitability of heart muscle, which is why a deficiency can contribute to heart palpitations (also known as heart arrhythmias). Only three percent of Americans meet the adequate intake of potassium, and the average American intake is just over half of the requirements. Another major function of potassium is blood-pressure regulation by decreasing sodium reabsorption, which is one reason why when sodium is out of balance, potassium can be too.
- Magnesium: Magnesium is a third essential mineral directly related to the excitability and contraction of muscles, including the cardiac muscle. It’s responsible for maintaining normal amounts of electrolytes inside heart muscle cells, and it’s a mineral in which many of us are deficient.
Addressing Heart Palpitations on Keto
Keto-related heart palpitations are usually short-term and only experienced during your transition to the ketogenic high-fat diet. This is when your electrolytes are most likely to become out of balance. That means that as you regulate and settle into ketosis, these symptoms should resolve. Here are some steps you can take to alleviate heart palpitations:
Stay Hydrated
If dehydration is the cause, hydration is the cure! Add Himalayan salt to your water (a pinch); it will help keep your essential minerals balanced and also possibly prevent keto flu symptoms while the body is adjusting to its new power source.
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Increase Salt Intake
As mentioned earlier, sodium plays a crucial role in maintaining fluid balance and nerve function. Adding a pinch of Himalayan salt to your water can help replenish lost sodium.
Supplement with Magnesium
Magnesium is a mineral that most of us are deficient in and can be difficult to get from our diet alone, as modern soil tends to be depleted in magnesium (from pesticides and over-farming). Consider taking a magnesium supplement to ensure you're meeting your daily needs.
Important Considerations
When to Consult a Doctor
If your heart palpitations happen infrequently and go away fast, they likely are not serious. However, it's essential to be aware of situations that warrant medical attention:
- Existing Conditions: In case you suffer from diseases such as diabetes or hypertension, it is very likely that your heartbeat increases in frequency, this is because by decreasing the consumption of glucose decreases the need to take medications to reduce diabetes, as well as hypertension improves markedly with a low carb diet; therefore the usual dose of medications that you usually consume will be very high causing heart palpitations.
- Underlying Heart Issues: If you have increased risk factors for cardiovascular disease (including heart disease), such as diabetes, obesity, high cholesterol levels, or high blood pressure. A condition called atrial fibrillation can also be a cause.
- Persistent Palpitations: If you continue to experience high blood pressure and heart palpitations it can be due to dehydration and lack of salt content in the body from the diet.
The Broader Picture of Low-Carb Diets and Heart Health
Recent research has found that removing carbohydrates from your diet may cause heart issues. Specifically, it has been suggested that those consuming a lower proportion of their total daily calorie intake from foods such as starchy vegetables, and fruits and grains may have an increased likelihood of developing atrial fibrillation (AFib) - one of the most commonly diagnosed heart rhythm disorders. AFib, a sub-type of arrhythmia, is characterized by an abnormally fast or irregular heartbeat. Irregular or quicken heart rate. Some people with AFib may be unaware of their irregular heartbeat due to a lack of noticeable symptoms.
A large community-based cohort study examined over 13,000 participants’ health records over a 20-year period. The study was the first of its kind and largest to investigate the links between AFib and carbohydrates. Over the longitudinal study, participants were required to indicate their daily food intake from a 66-item food questionnaire. From this, the researchers were able to calculate the proportion of calories that were derived from carbohydrates. For most participants, carbohydrates made up approximately 50% of their daily calories. In order to ascertain AF, ECG data were collected during examinations as well as through the analysis of death certificates and hospital records. Upon analysis, it was found that across the 20-year period, 13.5% of participants developed AF.
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There are several processes in which low carbohydrate diets might lead to the onset of AFib. It is suggested that those following low carb diets might also consume fewer grains, fruits, and vegetables which have well-researched anti-inflammatory properties. Therefore, without these foods in their diet, a greater amount of inflammation may occur, which is associated with AFib. This study’s findings align with a body of literature, several of which have demonstrated that diets both high and low in carbohydrates are linked to increased mortality. This study differed from previous ones as they did not measure the extent to which the non-carbohydrate part of the participant’s diet affected the pattern. One of the researchers working on the study noted that the long-term implications on carbohydrate-restricted diets are quite controversial, particularly in relation to cardiovascular disease. Based on this research, they recommended that following low carb diets to manage weight should be done so with caution.
Is Keto Right for Everyone?
The keto diet can be a great tool to lose weight and improve one’s health but it’s not right for everyone. There are plenty of other great nutritional plans out there to follow that will lead you to a healthier lifestyle.
The keto diet is not suitable for people with a number of conditions, including: pancreatitis, liver failure, carnitine deficiency, porphyria, disorders that affect the way their body processes fat.
A ketogenic diet may benefit some people, such as those with obesity or type 2 diabetes and children with epilepsy.
People who are thinking of starting a keto diet should first talk to a healthcare provider who can help them decide if it’s a good option for them.
Ketosis vs. Ketoacidosis
Because the keto diet is a low-carb diet, your body may enter ketosis naturally. Symptoms may be similar to that of the flu. But you may be wondering if ketosis is safe for everyone. A ketogenic diet induces a state called ketosis. This is different from ketoacidosis, a serious condition that can happen when a person is unable to manage diabetes. Ketosis is a natural metabolic state that may have benefits for weight loss (1, 2). It may also have therapeutic effects for people with epilepsy, type 2 diabetes, and other chronic conditions (3, 4, 5, 6). Ketosis is likely safe for most people, especially if they follow it with a doctor’s supervision. However, it can have some negative effects, especially at the start. It’s also unclear how a ketogenic diet may affect the body long term (7).
Ketosis is a natural part of metabolism. It happens either when carbohydrate intake is very low (such as on a ketogenic diet) or when you haven’t eaten for a long time. When this happens, insulin levels fall and the body releases fat to provide energy. This fat then enters the liver, which turns some of it into ketones. During ketosis, many parts of your body are burning ketones for energy instead of just carbs. This includes your brain and muscles. However, it takes your body and brain some time to “adapt” to burning fat and ketones instead of carbs. During this adaptation phase, you may experience some temporary side effects.
Minimizing Potential Side Effects of Ketosis
Here’s how to minimize the potential side effects of ketosis:
- Drink plenty of water: Consume at least 68 ounces (2 liters) of water a day. A significant amount of weight lost in ketosis is water, especially in the beginning.
- Get enough salt: The body excretes sodium in large amounts when carb intake is low. Ask your doctor if you should be adding salt to your food.
- Increase mineral intake: Foods high in magnesium and potassium may help relieve leg cramps.
- Avoid intense exercise: Stick to moderate levels of exercise in the first week or two.
- Try a low carb diet first: This might help you reduce your carbs to a moderate amount before moving onto a ketogenic (very low carb) diet.
- Eat fiber: A low carb diet is not a no-carb one. Ketosis typically starts when your carb intake is less than 50 grams a day. Eat fiber-rich foods like nuts, seeds, berries, and low carb veggies (7).