How to prevent muscle twitching on a ketogenic diet

I made a pretty interesting discovery about the mechanism behind muscle twitches (also called benign muscle fasciculation syndrome) in relation to a low carbohydrate ketogenic diet. I gave the very low carbohydrate diet many attempts in the past. Whenever I would lower my carbohydrates below around 50 grams per day, I would get muscle spasms all over my body. A muscle would contract only once and then a few seconds later another muscle somewhere else would contract. Most of the time it wasn't visible but I could feel it every time. It feels like all your muscles are charged and could contract every second.

Muscle Twitching
With muscle twitching, it feels like your body is always a millisecond before a contraction

I have discovered what causes this on a ketogenic diet. And even though I mentioned before that salt was helping, it actually has nothing to do with salt. Any relief from a high salt intake was only temporary and I would have to take increasing amounts of it. (At this point I also want to mention that I no longer follow a ketogenic diet, you can read a new blog-post about my current diet.)

I will tell you how I discovered this and how you can prevent this on a ketogenic diet.

As I was researching these symptoms in relation to keto, electrolytes and magnesium were always mentioned. But both would not help. So I didn't find the solution here yet. 

One day I researched keto in high altitudes because I was planning to go on a hike in the alps. With nuts as my fuel source as they are the most calorically dense whole plant food. I found out that eating ketogenic while in high altitude can be tricky. And here it also gets tricky and technical to explain this.

As the air is less dense at high altitude, you have to breathe a higher volume of air to absorb the same amount of oxygen. This is problematic because the body will lose a certain amount of CO2 per air volume that is breathed in and out. It takes a couple of days for the body to adjust to this and reduce CO2 loss. 

In the cells, there needs to be a balance of CO2 and O2. So with the loss of CO2, the cells are also not able to take up enough O2 which can be deadly in extreme cases. That is also the reason why hyperventilation (aka Wim Hof breathing) is dangerous. Don't do it. You won't increase O2 levels by doing this but actually decrease cellular O2 levels exactly because this balance needs to be maintained. In order to prevent the loss of CO2 (and therefore O2), the blood vessels in your brain restrict and you feel dizzy. 

The problem with ketogenic diets in high altitudes is that, as the body uses fats as it's the main source of calories, it needs less oxygen for the same amount of energy output. Less oxygen utilization means also less production of CO2. This is widely known and used to measure an athletes state of fat utilization through breath analysis, so I won't go into that here. At high altitude, this can potentially be a problem, because less CO2 is available in the cells. In altitude, the increased breathing volume pulls the CO2 from the body, and O2 levels might drop to critically low levels. But here the body can adapt over time as well and you also require less oxygen, so it balances out.

But what has all this to do with muscle twitches on keto?
I did not make this connection until a couple weeks later. I was trying the very low carb diet again and had the same issue. Muscles started to twitch, salt did not help anymore and so I ended up researching for benign fasciculation syndrome. It is not so uncommon and many people experience it at least once throughout there lifetime.
Probably everyone knows the annoying eyelid twitch. But that is not what I had. My muscle would twitch only once and then another one would twitch.

And then I also found this video. It is in german, but this doctor made a genius discovery. He has discovered that CO2 is relaxing and that low levels of it lead to nervous system over-excitement. He has connected the CO2 loss in his patients to increased breathing, caused by stress. Everybody knows that in stressful situations you increase your breathing. In order to quickly run away from a lion, this was probably a helpful adaptation. But constant low-level stress (where you sigh) has the negative side-effect of increased loss of CO2. Low energy levels because of low cellular O2 levels follow.

Through controlled and slow breathing I was able to completely stop my muscle twitching. It took only about half a day. I guess after a couple of weeks of strict keto this side effect would have subsided by itself. But I never went that long to find out because I was too concerned about it and increased my carbs. Now, after eating ketogenic or very low carb for a long time, I never have this issue anymore. The body adapts to the decreased production of CO2 by holding on to more of it, it seems.
Interestingly, I only get the twitches sometimes after intense exercise. Which, for me, is another sign that this theory could be true. Because, after intense exercise, the increased breathing persists for some time after you actually finish and you lose CO2.


The adaptation to keto is partly comparable to the adaptation to high altitude. Because less CO2 is produced in the burning of fats, the body has to adapt by conserving more of it. This could also explain why some people feel the keto-flu, where they feel low in energy. 
The solution is simple though. Pay special attention to your breathing for a while and breath slowly and regularly. While sitting, I am now at about eight in- and out-breath per minute. 

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