Can't lie down

I have had a significant increase in palpatations during the past week. I was attempting to adapt to an extremely low carb diet, but the palpatations became too annoying. It culminated in an 18 hour afib episode last night, The second one I've had in a month since going very low carb. I'm back on a relatively low carb diet now, about 100-150 grams, but the palpatations or skipped beats won't stop. They get significantly worse when I lie down, and pretty much go away when I'm walking around. I had increased my potassium to almost 2000 mg /day during the week, because it seemed to calm the skipped beats, but that culminated in the afib episode last night. Mag is at about 1600 mg/day. ( I used to be at bowel tolerance around 800 mg, but that doubled during the very low carb diet). I also used to be an adrenergic afibber, but now my symtoms are all vagel. ..........Anyway, I can't lie down or the skipped beats increase to about 1 every 3 beats and it feels like I'm going into afib again. Any suggestions would be helpful on how to calm the palpataions when lying down. I've read ginger may work for some, I have ginger tea which I may try. Don't want to go another night without sleep, or worse, fall into another afib episode.

thanks everyone

Are you on a beta-blocker? They had that affect on me after being on them awhile (50 mg of metoprolol a day). I have vagal afib, and metoprolol made it much worse after about 3 months.

Diane

Thanks Diane , but no, I'm not on any meds.

John,

For vagal issues, I took a tsp of organic ginger spice before bed.

George

Hi, John,

So sorry to hear of your current difficulties. Been there and done that. In 2010 I tried to move too quickly to a low carb diet, and the result was that I found myself much more vulnerable to AF episodes. There was a general sense of instability and sometimes things that had never been related to AF suddenly put me in arrhythmia.

For what it's worth, one of my friends who does not have AF ended up in the hospital with an irregular heartbeat after starting a low-carb diet and moving too quickly away from his previous diet. I don't think this is just restricted to those of us who are particularly vulnerable.

You may want to consider trying to adapt a bit more slowly to a low carb diet. Further, you may want to consider just how low you want to go, since there is evidence now that some measure of "safe starches" (potatoes, rice) may be healthier than going as low as you can with carbs. I found that I was much better off when I went with a diet that was based on Paul Jaminet's Perfect Health Diet (see his website, if you're interested: Perfect Health Diet.

Hope you get to a less stressful place soon, but I would also say that it may take some patience. When I was experimenting with this I was already at a place where my episodes were sometimes longer than 24 hours and it took time to even try to understand what was happening with any kind of change. This is a hard place to be, since you want most of all any sign that you are moving in the right direction.

Best wishes,

Robert

Thanks George, the tea helped some last night, and I'll get some ginger. Thanks also Robert, that web sight was interesting, I'm going to read more and maybe buy the book. I think I benefitted in the attempt to go very low carb, it seemed to significantly improve my reflux issues, and I lost my cravings for sugar. It must have been to drastic a change for my system. I also wouldn't do it again without a cardymeter as George recommended, so I could keep close tabs on my potassium. as it was, I didn't know whether to add sodium or potassium. The other interesting thing which I have no explanation for is that my bowel tolerance for magnesium doubled, and I'm still increasing it using Epsom salt baths and topical Mag.
Feeling somewhat better today with ectopics occurring every 3-4 min. I'm going to stay in the 150 gr range for carbs for a while, still a significant decrease ( probably about 1/2 as many carbs as I was eating before) and see how it goes.

Thanks again,

John

I haven't found that a very low carb diet has increased my ectopic load and I haven't had an afib episode since I switch to low carb.

Josiah

John, you may wish to have a comprehensive metabolic panel done to see what's going on with your electrolytes.

______________
Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

John

I had similar problems to yours when I went low carb the first times. I discovered a solution to this type of problem from Volek and Phinney.

See pages 80 -81 The Art and Science of low carbohydrate performance: -

"When carbohydrates are restricted the body changes from retaining both water and salt to discarding them. Because of this fundamental shift in mineral management, it's not unusual for people to lose 4-5 pounds of water weight during the first week of a low carbohydrate diet. Typically, only half of that first week's weight loss is from fat and the other half is due to salt loss along with its associated water. If some of that salt is not replaced, however, blood flow may be impaired and the body over-reacts in its quest for salt. This primarily happens in the kidneys, which try to compensate by wasting potassium ( i.e. kidney cells give up potassium in exchange for retaining sodium, leading to a negative potassium balance. ..... The easy solution is to routinely take 1 - 2 grams of sodium per day in the form of 2 bouillon cubes (or home made broth). Some bouillon cubes contain less than 1 gram of sodium so be sure to check."

This advice might work for you, it worked for me. What is pertinent for the a-fibber is the loss of potassium as the result of the loss of sodium.

This advice is only for those who go low carb.

Peter

Thanks everyone for the input. I actually did have a metabolic panel done Last Monday, still waiting for the results. I did start adding some sodium, maybe a little late (3-4 days) into the process. At times I thought it was working, but then the skipped beats crept up again. I then started adding gradually increasing levels of potassium, which I thought was helping until I had another vagel episode 3 days ago. I decided to quit trying to stay below 50 grams /day, and increased my carb intake to about 150 grams /day. Actually, I've had minimal improvement in the ectopic beats . I cut back on the potassium, but then added 500mg again last night as a last resort to try to be able to lie down without skipping beats every 5 seconds. That seemed to work. Still skipping all day today.

Hi John - do you have a Cardy Meter? It can be very helpful when you are tinkering with supplements to know what is going on with your Potassium levels.

Mine are quite erratic. During the night at about 2 to 3 AM they can spike to levels of about 4.7 or 4.8 and the resulting hard heart beat feels harsher than when my levels are low. This condition wakes me up, so I go for the Cardy and test to see what is going on.

During the day the levels can go below 3.5 and I can also have a hard heart beat, but it is different and not so harsh as when it is higher.

We get a lot of Potassium through our diet and don't think I would be comfortable taking supplements without knowing my levels.

For sure it is not a good idea for me to be taking K supplements after about noon as it seems when I do the potassium spikes higher in the night, and I would not have understood this uncomfortable feeling without being able to test for it. I wish there was such a simple test for the rest of the electrolytes, but there is not, so we can only play cat and mouse and deduce from the known potassium levels what is going on.
Ron

Ron B - A lot of the resltant potassium activity from supplements depends on how optimized your intracellular magnesium is. If marginal or low, then the additional potassium will be unsettling rather than calming. Always remember, it's the magnesium that is the foundation that allows potassium to function as it should.. The other huge influence on potassium is the sodium interference or competition from hidden food sources.

I just had my well water tested and was surprised to learn that there is a relatively high sodium level...which may help explain why my potassium needs constant monitoring and I do supplement regularly with the potassium gluconate powder...and for me, that helps significantly. When I learn more abut the water influence, I'll post again. It may not be significant but the numbers on the report were surprising. I would have never suspected my well water as a source of sodium.

Jackie

As I've previously posted, while I was adapting to a low carb diet, I experienced the same issues as Peter Ohlson. I was not then aware of the sodium issue. I knew that an electrolyte problem was possible during adaptation. Whenever I'd lay down at night, my heart felt like it was beating hard. I supplemented significantly on top of the 2-3g/day that I was currently talking, to no avail. This happened for several evenings and I had the feeling I'd end up in afib, unless I could do something different. After a few days, I did wake up in afib around 1AM, with a vagal episode (which is what I always get). I converted with PIP flecainide in about an hour. After conversion, I woke up at 3:30 AM with my heart in NSR but beating around 130 BPM. After I convert with flec, some elevation is normal - say in the 80's or so. This was unusual. I took 400 or so milligrams of magnesium citrate powder - much faster acting than a tablet. After about 10 minutes, my heart rate slowed back down into the 80's, on a very linear drop.

I subsequently pushed my mag hard, keeping it near bowel tolerance. I later also learned about sodium excretion in a low insulin environment (in this case caused by the low carb diet). I then started using some sodium in my cooking.

In any case, I've never had a problem subsequent to being keto-adapted. While I've remained adapted for 5+ years, I tend to flip in and out of ketosis, depending upon my diet. If I've been a bit carby for a few days, I'll commonly get very strict, or fast for 24 or 36 hours to put me back in deep ketosis. When I'm fasting, I take no sodium but I do supplement with my regular K & Mg. This fasting has never been an issue for me.

In summary, post adaptation, no low carb related afib issues. The benefit of having an almost endless fuel source that never "goes low" has been well worth the hassle.

George

Thanks Jackie - I had backed off some on the Mg supplements from 900mg to 600mg. Things seem to be settling down, or maybe I am getting used to the cycles through the day. I have only been supplementing with K on an as needed basis. I was able to get a supply of the 595mg caps (the only ones available in Canada are the 99mg tabs) so I think I will start with one of them in the morning. Since I have eliminated my night time indigestion (thanks to you for some effective suggestions), and getting lots more sleep and generally feeling much better, I am making a wild guess that my gut is now absorbing nutrients much better. It is always my desire to reduce or eliminate some of the supplements.
Ron

Ron,

Have a close look at your 595mg caps. They almost certainly have less than 100mgs of elemental magnesium.

Sam

Ron - I agree with Sam... check the Mg label closely.... or did you confuse the dosing on potassium label? They are typically limited to 99 unless you buy professional grade or the bulk powder.

Just remember, magnesium repletion can often take a very long time. If your are refractory, then you never fully replete so the intake has to be constantly optimized at wherever you stand with the bowel tolerance issues. Some forms of magnesium are better tolerated and also better absorbed than others.

Yu just have to keep at it.

Be well,

Jackie

Sam, Jackie - you are both right. My mistake. The label on the front of the bottle says Natures Bounty Potassium Gluconate 595mg. On the back of the bottle is says 99mg - 3% of daily value from 595 mg potassium Glyconate. Too bad, it would have been nice to have a 500mg dose in a capsule form for travelling.I was given 600mg x 3 capsules of potassium chloride in the hospital when I was low, so assumed this is what I was getting.
Ron