Another thread lead me to the 'argument' discussion between CarbSane and Stephan Guyenet / Dr Harris.
If you haven't had a chance to see it, I'd recommend taking the time.
Not sure what's up with the text/background choice. It's unimaginably distracting. I just did a "Control A" on the whole page to highlight the background full blue and make the words white. Easier to read.
Anyway CarbSane seems to push the notion that too much NEFA and VLC could cause tachycardia and other vascular related issues. Kurt and Stephan give their responses and it's pretty fascinating to read through.
To provide a little background (incase Dr Harris sees this! - here's hoping). For those that already know all this... feel free to skip this part.
Of course, I come at this from my perspective that somehow, something in my diet is causing me problems, given my VAP numbers, and even more so, the persistent unsettling feeling I've had in my chest since going VLC last year. Sometimes I feel like the bloodflow around my heart is restricted, and it's actually painful every now and then. Sometimes my heart seems to "sink" for a second, like it took a "gulp". It's very strange. It's not constant, and is worse at times and better other times. I've also noticed it's completely absent after a good weight lifting session.
Doc already performed EKG at my insistence. Also xrays and blood test. Everything "checked out good." Docs say I need Lipitor and low fat whole grain diet. They really don't offer me any help beyond that so "Go see a Doctor" is almost pointless for me.
Around December, I settled into a Lacto-Starcho-Paleo type diet, based on everything I had learned from my favorite health bloggers. Since then, I have been eating approx 50F/30C/20P. Most of my fat is saturated and some mono with the least being pufa. Here is what it looked like Dec 2010-June 2011.
FATS: healthy beef (usually GF), bacon, pure heavy cream, pasture butter, hard cheeses, GF ghee, avocado, coconut oil, wild sockeye salmon, mac nuts, pecans, almonds.
CARBS: sweet potatoes, potatoes, white rice, berries, bananas, dried figs.
PROTEIN: Pastured Eggs (about a dozen per week), meats, pure whey protein isolate. (heavy lifting 3-5x per wk).
Changes I've made since July 8:
Eliminated bananas, figs, and nuts completely.
Eliminated Creatine completely (last week)
Eliminated Coconut Oil and caffeine completely (last week - to see if I am having a reaction to these)
Reduced heavy cream and butter intake by more than 50% (to reduce sat fat intake)
I want to make it clear that I am not asking for medical advice here. I am asking what you all think of the discussion in the link in the context of someone who eats Paleo but has to adjust because of the issues mentioned. I give you my 'story' here only to give you context of why I am asking because some of the things discussed could be important to understanding this puzzle.
Glucose is discussed heavily here as well, and I am having a hard time making out what is being implied. All three agree that safe starch is good and beneficial, yet some notes in there seem to implicate that high glucose coupled with high fat intake could be dangerous, even in slim and fit people. Of course, this has my attention because I eat about 25% safe starch in my diet.
Could CarbSane be correct that a VLC carb high in fats might be responsible for vascular issues and dangerous heart conditions as discussed? Or are Dr Harris and Stephan more correct in saying that elevated NEFA couldn't possibly cause sudden cardiac death?
Where do PaleoHackers stand on this? Also, If Kurt Harris gets wind of this question, I would LOVE!!! to hear his take on this outside the space of CarbSane 'arguing' with him.
Reading the interchange between Carbsane and Dr. Harris gave me a certain tightness in the chest (and other areas). I plan to address this by taking a long time out from the Internet.
Jesus Harris is right, carbsane is doing what -some- people like to do and equating a pathological condition with a non-pathological one that is similar in some respects. NEFA become pathologically elevated when either they can't make it into the cells, or they can't properly be metabolized due to impaired skeletal muscle uncoupling protein (UPC3) expression. Stephan has talked about this, it is in his opinion the main reason why leptin resistance often leads to insulin resistance because the build-up of fat in the cells impairs the functioning of the insulin receptors, or maybe it was the glucose transporters, I dunno, either way it's bad and then you get high insulin and glucose, which is the result of the lipotoxicity. It isn't fair to say that people without leptin resistance have lipotoxicity just because their NEFA levels are higher than those not eating as much fat. http://www.ncbi.nlm.nih.gov/pubmed/15294045 http://diabetes.diabetesjournals.org/content/50/suppl_1/S118.full.pdf
It's not about how much there is necessarily but whether it is spilling into tissues like the heart that is the problem. Can it go where it needs to go (mitochondria)? If not it loiters in your heart. You could do the mirror test. 1. Look in the mirror. 2. Is you fat? 3. If yes, then stoppit. If no then I don't think it's when Carnsane is proposing. You look ripped to me.
Jack have you considered the iron excess/copper insufficiency yet? It can certainly happen on LCHF diets and takes a while to normalize itself. I think you should go give some blood and see what that does.
My thoughts on carb intake are that we should attempt to come as close to matching our daily rate of glycogen depletion with carbs (preferably from tubers).
More importantly, it sounds like you're having cardiac arrhythmias. I have experienced these in the past and I've narrowed this down to low blood sugar (and maybe low calcium intake since I don't eat dairy). I've started to take 2tsps of calcium citrate a day and a minimum of 150g of net carbs from sweet potato. I almost never get these anymore. If it does occur, it's usually because I've miscalculated my glycogen depletion as a result of anaerobic workouts. I'll then eat a fair amount of sweet potato and it will stop. I think it's a fairly serious thing to be experiencing any sort of persistent dysrhythmia, so you shouldn't mess around with this.
Are you salting your food at all?
I was having the same symptoms and I had to go the ER because I was close to fainting while playing soccer, apparently I wasn't eating enough salt.
I feel like I blogged about this last year, but can't find my own post. Either way I had a "syncope" episode that was immensely frightening. I woke up in the middle of the night with a horrible cramp in my leg. When I got up to try to release it, I stumbled and fainted. When I woke up I was soaked in urine, my ears were ringing, and I was sweating, but had chills. I went to the ER and had a brain scan, ultrasound of blood vessels, etc. etc. and they didn't find anything. Maybe a more detailed vascular scan would have picked something up. I felt off for quite a while after that, cramping, weird heartbeat (they could't find any evidence of arrhythmia though), feeling faint, feeling crappy. I have managed to crawl my way into feeling normal though and now have no issues. It's hard for me to tell what I'm doing differently since I didn't keep a good food diary (that was dumb :( ), but I suspect I eat lower fat, lower protein and higher carb. I eat a lot more grains (particularly buckwheat) and a lot more salt. I eat a lot less dairy, almost no eggs, and a lot less coconut, though they are certainly part of my diet. I don't eat much bacon, but I still eat prosciutto at least once a week. I would say half my meals are pescatarian or vegan, admittedly some of these are just fruit. I have been over a year cramp-free and I am very happy with that. My blood pressure, which was dropping really badly, has normalized. I guess I'm highlighting the major issue with n=1 because it's hard to isolate what precipitated these changes.
I'm sorry I can't offer much in the way of science though. But after meeting so many red-faced low-carb folks at AHS, I've been researching vascular dysfunction as a function of excess protein and hope to compile some information. Maybe I'm being premature, but I were you I'd cut out the protein powder for sure. Then I'd look into throwing away the egg whites. And doing several low-protein meals a week.
While I'm not answering the question you ask, I will offer that looks to me like you may not be getting sufficient magnesium and selenium. Magnesium insufficiency appears to trigger various types of arythmia and what you describe could absolutely be that.
You wrote: "Sometimes I feel like the bloodflow around my heart is restricted, and it's actually painful every now and then. Sometimes my heart seems to "sink" for a second, like it took a "gulp". It's very strange. It's not constant, and is worse at times and better other times"
What you describe is also how some describe anxiety, which also can be triggered by insufficient mg.
Your n6 inake certainly is quite low compared to the general population but it does not appear that fish is a part ofyour diet while nuts and eggs are. It may be prudent to consider shifting around foods to lower n6 intake and increase n3 intake if you are currently getting more than a 4:1 n6 to n3 ratio.
It'll be interesting to hear responses more specific than mine. Hope you get it worked out soon.
I used to have cardiac arrhythmia when I was SAD. After cleaning my Lifestyle up (going paleo) I rarely have them now, I have been LC-VLC for years now and use sea salt. I actually had an episode of atrial fibrillation that landed me in the hospital once, pre paleo. This is what seemed to work for me. I do notice if I happen to chose to eat a lot of carbs my heart rate does increase for a couple hours after eating where as my normal LC meals do not have such an effect.
Travis, you are hysterical!
Folks here ... if you want to get the full picture about NEFA rather than where Kurt Harris went all immature frat boy on me, please take the time to read the label at the blog. Possible ischemia is a small part of the potential problem.
If you're diabetic and going VLC with significant weight loss has you still horribly glucose intolerant, while morbidly obese undergo GBP surgery and a 600 cal/day diet for 2 months had over 70% STILL diabetes free despite reverting to their regular diet for 3 months ... you need to at least wonder why rather than following the dogma.