In this post: <[
www.afibbers.org] , Lynda asked me to explain my caveat about keto diets for afibbers.
For those who aren’t familiar. Here is a description of keto diets. This is by a type 1 diabetic, who is an MD and uses a keto diet to manage his diabetes: <[
ketogenicdiabeticathlete.wordpress.com]
It has to do with electrolyte shifts that occur when someone transitions into a ketogenic state. This is a low insulin state. When insulin is high, the insulin signals the kidneys to conserve or retain sodium. When insulin drops to very low (and in my opinion, normal) levels, the kidneys are signaled to excrete sodium (called natriuresis of fasting). This can be dramatic enough that the body excretes potassium along with the sodium – trying to keep them in balance (body will secrete the hormone aldosterone causing it to excrete potassium). For more detailed explanation, see the books by Phinney and Volek <[
www.artandscienceoflowcarb.com] They recommend supplementing with 5g/day of sodium, at lest 1g/day of potassium and also magnesium.
Most peoples’ ketone system are in “mothballs” since many fuel on a mostly carb diet to continually fill up the small glucose tank in the body. It can take up to 2 or more weeks of starvation or a very low carb (generally 20 or 30 g/day or less) diet with modest protein to stimulate the body to bring this system out of mothballs. The body first empties the glycogen stores in the muscles to feed the brain (which can only fuel on glucose or ketones). Once these are depleted, muscle protein is converted to glucose for this purpose (muscle tissue can fuel on fat). After a while the body starts making ketones from fat and these ketones can offset much of the brain’s need for glucose.
Ketones are not produced in a high insulin state.
In my case, I did not know about the sodium supplementation recommendation. I dropped my carb intake to around 20g/day. I got all the symptoms of “keto flu” (which can be mitigated with appropriate supplementation). After a few days, I noticed a “pounding heart” when I went to bed. This is typically a symptom of low potassium, so I loaded up on it – I don’t recall, but likely 4-5 grams/day. This continued for a couple of days. One evening I thought, this will lead to afib. Sure enough I woke up with 3 AM afib. I converted it in about an hour with 300 mg of flecainide (as usual). Except this time I converted to a rate of around 130 BPM (my normal rate after a flec conversion is in the 80’s). This stayed this way for a while. I got the idea to take a bunch of magnesium (as this was 6 years ago, don’t recall how much, likely 400-800 mg). I did and within 10 minutes, my rate started dropping into the 80’s. I took a while, but I think less than 30 minutes.
That was in Oct of 2009. I’ve been keto-adapted since, though have gone in and out of ketosis many times. I’ve yet to have another afib episode related to this. I also likely get less than 5 g/sodium/day. All food is cooked from scratch. I do add salt, but not a huge quantity.
As to why I think a low insulin diet is healthy. It starts with Dr. Joseph Kraft. You can read his book - <[
www.amazon.com] A summary is here: <[
www.thefatemperor.com] Bottom line – Kraft did 14,000+ oral glucose tolerance tests WITH insulin assays. He found that 80% who had normal glucose responses had abnormal insulin responses. He called this “diabetes in-situ.” This does not count all those who had abnormal glucose responses. You need a fasting insulin of 5 or less to be in the clear. Kraft also did 3,000 autopsies and saw that excess insulin was the cause of much calcification in the heart, its structures and blood vessels. So keeping insulin low is a hot option. Here is an interview with him – he’s 96 and first published on this around 1976. <[
www.youtube.com] Catherine Crofts, in NZ, used the Kraft data for her PhD thesis recently. Here is a presentation by her : <[
www.thefatemperor.com]
In this post, they cite a study demonstrating that fasting insulin represents 50% of total insulin secretion for the day. This relationship holds for those with low and high levels. Hence someone with a fasting insulin of 30 produces 10 times the insulin over the course of a day as someone with a fasting insulin of 3. <[
www.buttermakesyourpantsfalloff.com]
The guys at Newcastle showed they could normalize glucose function by reducing fat around the pancrease (it is organ fat, not subcutaneous fat that is the issue) <[
www.sciencedaily.com]
In Hans’ newsletter, the editor did n=1 experiments with the Newcastle approach. Here is a search on the archives: <[
www.google.com]
Toronto doc, Jason Fung, talks about insulin and obesity <[
intensivedietarymanagement.com]
And has a many part section on fasting, staring here: <[
intensivedietarymanagement.com]
This is an old post, analyzing an older paper. <[
high-fat-nutrition.blogspot.ie] However, he plotted the data to highlight the risk of coronary heart disease risk vs A1C levels
In summary – I think low insulin levels are a healthy way to live. As to afib, there is risk to going into ketosis. If you want to try it, make sure you pay attention to the electrolyte supplementation best practices. Can you get into ketosis slowly and mitigate the risk? I don’t know, I’ve not tried it. I have a friend who said she did. I’ve also read that it isn’t possible. I don’t know the answer. Will it help your afib? Perhaps, especially if you have comorbidities like hypertension and coronary artery disease. It was not a ticket out of afib for me. I already had that ticket to afib remission- primarily magnesium to bowel tolerance, but also taurine and earlier potassium.
My friend, a Wolff White Parkinson ablatee has to eat keto to prevent rapid, debilitating PAC's from happening in high end exercise. Her story is written up here <[
www.afibbers.org]
I’m a great fan of living this way. I can fast for days if I want. I always exercise fasted. I never have to stop to eat. My insulin levels are low as is my A1C. Is it for all afibbers – you have to evaluate your situation carefully and do your research.
George