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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.

CarbSane - NEFA discussion

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.

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 Unfortunately, it is not possible for me to discuss this here as "Carbsane" has now showed up and is determined to turn paleohacks into a facsimile of her own blog by starting a name-calling festival. This is what is known as the tragedy of the commons. Make something free and people will show up just to ruin it. It is one reason I spend little time on the internet these days. – Kurt G Harris MD Aug 8 2011 at 23:51
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 CarbSane - I think it's more like... most people here think you're out of line because you seem to have chimed in only to stir up more trouble. I did not choose a side in my question. I did that on purpose for neutrality toward the content so I can be open to answers from both sides of the argument. – Jack Kronk Aug 9 2011 at 13:39
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 I don't know you and I am not all that familiar with your work, but I gather that you seem to have a decent platform to work from and agree with most of the things that we support here on PaleoHacks. The thing that is somewhat bewildering, is your choice to irritate people instead of winning them over to your way of thinking (yes, a stolen line from How to Win Friends). – Jack Kronk Aug 9 2011 at 13:43
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 I tell you what... if you want to win me over a little, take the time analyze my question and give me your best shot at what you think might be going on. Contribute to this discussion in a postive manner like the others have done below. If you think you're a leader but nobody's behind you, you're just takin a walk. Win SOMEBODY over CarbSane. – Jack Kronk Aug 9 2011 at 13:46
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 CS - I have to say I rarely read your blog, despite some interesting info, in part due to the tone. The bitterness is distracting and makes me more curious about your intent and what floats your boat than about the factual information. I wish you would take a more constructive bent. In fact, every time I see your name in a comment on some other blog post, I wince a little, waiting for the barb. If that's who you want to be and your style, fine. If it's not, well... – Evolutionarypsy Aug 10 2011 at 0:04
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9 Answers

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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.

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 Quality post. Still laughing as I type this. – Travis Culp♦ Aug 8 2011 at 18:47
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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.

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 i think the thought alone of giving blood would raise my cortisol too much, causing my blood pressure to rise along with blood sugar, giving me heart palpatations and chest pain, making my face pale and sickly, thereby causing excessive persperation, which would lead to dehyrdation and sodium deficiency, causing renal failure, and sudden death. Is there any way to lower iron other than giving blood? I really don't like that idea very much. – Jack Kronk Aug 8 2011 at 19:38
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 I could stab you. – Stabby Aug 8 2011 at 19:39
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 I want to start a parody blog now called Carnsane! – Bread-Eating Beelzebub Aug 8 2011 at 20:24
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 He kept getting magnets stuck to himself. – Stabby Aug 8 2011 at 21:10
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 When I was in medical school the blood bank got 175 free pints of blood by requiring us all to donate. It's really no big deal. Just tell them to use a large needle so it goes fast... – Kurt G Harris MD Aug 8 2011 at 23:12
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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.

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Travis - I work out HARD, every.single.time. And I have just switched up my program to 5x a week working only 1-2 muscle groups versus total body workouts 3x /wk. Am I depleted my glycogen tanks all the time? I mean, seriously... I could see this being the case. When I get down I am beat, but it is when I feel my very best. No odd feeling in the chest at all. It's really wonderful. I've tried protein before/after. Can't really notice a difference either way. As for calcium, I was getting my fair share of dairy from several sources, so I do not suspect that I am not getting enough calium. – Jack Kronk Aug 8 2011 at 19:18
Low blood sugar? Now that could be. My father was hypoglycemic (and quite severely so). But that was his doing. He made very poor choices while managing that. But at least I know that it does run in my blood upline. – Jack Kronk Aug 8 2011 at 19:21
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 Well, I think there's this somewhat prevalent behavior where someone does a killer leg workout and eat a sweet potato and figures that it should be sufficient, but they're failing to recognize that even if they were bed-ridden, they'd be burning through 5g of liver glycogen an hour. It takes A LOT of (relatively carb-sparse) sweet potato to fuel heavy hypertrophy workouts + replete liver glycogen stores. A 300g sweet potato is only like 45g of carbs. – Travis Culp♦ Aug 8 2011 at 19:43
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 Yah I just have always been between the fences. One side says your body will produce it via gluconeogenesis, even if you don't eat the glucose. So I figured some starch at least alleviates a big percentage of that versus someone who is strict low carb and still smashes the weights. I suppose I can try more sweet potato/potato and see how I feel. – Jack Kronk Aug 8 2011 at 19:51
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 CarbSane: Set aside your lunacy for a moment and see that we are likely in complete agreement. I advocate ingesting an amount of starch that matches what I presume to be the amount of glucose the body wants. No more, no less. This is not a controversial point. Relative to the SAD, it is technically "low-carb" but I consider it to be "appropriate carb." – Travis Culp♦ Aug 8 2011 at 19:53
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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.

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ROB, I suspect that I eat a low sodium diet, giving my choice of food now compared to what it was, which was often prepped meals by Trader Joes or whatever that had loads of sodium in it. However, since reading some interesting comments from Ray Peat about the importance of salt, I have began sprinkling a little extra. I use pure sea salt, and I use a salted pasture butter, and the bacon I eat has salt, and I always salt my eggs. – Jack Kronk Aug 8 2011 at 19:43
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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.

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 And not to keep pimping the human biodiversity angle, but I suspect the ability to handle protein varies quite highly among humans. – Bread-Eating Beelzebub Aug 8 2011 at 20:09
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 huh, carbsane, interesting. Cordain is a salt hater and "In these younger normotensive and hypertensive subjects, dietary salt restriction increases resistance to the vasodilating effects of insulin." ncbi.nlm.nih.gov/pubmed/8873692 – Bread-Eating Beelzebub Aug 8 2011 at 20:10
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 carbsane, are you sun-burned in the pics on your site where you have red skin? – Bread-Eating Beelzebub Aug 8 2011 at 20:11
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 It's probably booze! Teehee! – sarah-ann Aug 8 2011 at 20:24
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 huntgatherlove.com/content/unwelcome-visitor – Matt Aug 8 2011 at 20:25
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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.

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 You may be right, but in my experience magnesium intake was held constant while I adjusted those other two variables and they made a difference. I could see a deficiency in any electrolyte being a potential cause however. – Travis Culp♦ Aug 8 2011 at 18:37
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 oopsie. I forget to mention fish. i eat wild ocean sockeye salmon regularly. we just bought another huge slab of it and cut it up into about 5 or 6 meals. I think my o6 intake at this point is insanely low. I even cut out nuts. My only source of o6 pufa now is bacon and occasionally chicken. As for magnesium, what is the best supp to take? And to Travis, what did you mean by your closing comment above? – Jack Kronk Aug 8 2011 at 19:05
Na, Cl, K, Ca, Mg(and apparently HPO4 and HCO3) could all be responsible, though I doubt it's the latter two unless your phosphorus intake is somehow really low. – Travis Culp♦ Aug 8 2011 at 20:32
phosphorus has probably been really high until recently with the bananas and figs. What about just taking a multivitamin. I know that's not what most people here recommend, but wouldn't that be a shotgun approach to possibly fix the problem? – Jack Kronk Aug 8 2011 at 20:52
Well, calcium specifically binds with the minerals in a multi, so you're likely getting less than optimal amounts of each. I try to segregate my supps so as to have less of a blackbox phenomenon. I do 400mg a day of magnesium glycinate or aspartate and haven't suffered any ill effects. – Travis Culp♦ Aug 8 2011 at 22:06
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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.

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I am with Dr. Harris on this, on all points.

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 Care to elaborate? – mari Aug 8 2011 at 20:10
He just doesn't seem to think that low carb is a problem here, that it will cause such a serious heart problem. – The Loon Aug 9 2011 at 4:13
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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.

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 CarbSane, why do you always resort to name-calling and bitchiness? It seriously weakens your argument. You might have something interesting to say but the ad-hominem crap just turns me right off. – sarah-ann Aug 8 2011 at 19:36
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 I don't see the part where Kurt Harris went frat boy. The arguments are quite clearly laid out. But your website background is very unique, and welcome to paleohacks! – Kamal♦ Aug 8 2011 at 19:39
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 CS, you must wonder why you continue to get this type of reaction whether it's you. I know of lots of bloggers that go against the VLC grain and they don't get the reaction you are alluding to. Ever thought of why that is? Melissa above said something not a million miles from your point just one post above you and she got curiosity and considered opinions instead of ire. Sand down the chip on the shoulder a little and you might actually change someone's mind instead of just preaching to people as embittered sounding as you. – sarah-ann Aug 8 2011 at 20:22
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 LOL, the always-mature Carbsane strikes again. Just be happy she doesn't have children. :-) – Archie Aug 8 2011 at 22:19
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 I trolled you? You spammed my favorite blogs - ones I've been reading every day for 4 years - long before you were on the scene -attacking the authors and anyone else with whom you disagreed with your sneering derision. I merely gave you your own medicine a few times. Try counting the number of blog posts I did about you or the number of times I've mentioned you on my blog - ZERO. Who is trolling who? And what are you doing here at paleohacks with folks who think there might be more to talk about than how evil and stupid low carb advocates are? – Kurt G Harris MD Aug 8 2011 at 23:37
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