Palpitations: The Most Common Causes by Dr Justin Gallant ND

Common causes of Palpitations

Palpitations can be a scary sensation. Most patients describe them as a fluttering, racing, painless throbbing or just an awareness of the heartbeat. While these may seem random, there is usually something causing them. I’m going to go through the most common causes that I see in my practice unrelated to actual heart issues. Palpitations should definitely be investigated if they are frequent, severe or getting worse and worse and this article by no means is replacing a proper work-up. These are just some of the common reasons I see in my clinic. 

  

Click on "Read More" to read the rest of the causes. 

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Magnesium Deficiency and Palpitations

​Magnesium deficiency and palpitations: A magnesium deficiency is difficult to test through blood work. I find that even if the serum magnesium or RBC magnesium are within the reference range some patients still benefits from taking a magnesium supplement. If there are other magnesium deficiency symptoms occurring such as calf cramping and muscle spasms you should consult with your MD or ND to determine which type of magnesium you should take and what dose.

Iron Deficiency and Palpitations

​Iron deficiency and palpitations: It’s verrrrrry common in my practice to have patients experiencing frequent palpitations to have a ferritin below 15ug/L. Usually once their ferritin increases to >50ug/L, the palpitations subside. Check out my iron deficiency article to learn more about this topic. 

Low Blood Sugar and Palpitations

If palpitations are mainly happening in the middle of the night or if you haven’t eaten for more than 4 hours there’s a good chance that your palpitations are being caused by hypoglycemia. When your blood sugar gets too low you secrete cortisol and adrenaline. These stress hormones provoke palpitations just as they would if someone just cut you off on the highway. If you have really low blood sugar you’re basically already at an 8/10 and it’s not going to take much to put you to 10/10 and palpitations will start occurring. For more on this topic check out my article on insomnia. 

Anxiety, Panic and Palpitations

​Any stressful emotions can trigger palpitations due to the increased production of cortisol and adrenaline. Most patients who experience palpitations and anxiety will get palpitations when feeling their most anxious and especially during panic attacks. Sometimes these palpitations improve when supplementing with magnesium but then we have the chicken or the egg paradox. It’s difficult to say if they had a magnesium deficiency causing anxiety or if magnesium just helped soothe their tension and anxiety. 

Stress and Palpitations

If palpitations occur infrequently and only when you are stressed to the max, there is a good chance that it’s is solely stress that is causing your palpitations. If the small stressors are causing palpitations, there is a good chance that there are other contributors present. If you drink 3 large coffees per day or skip meals, there’s a good chance smaller stressors are going to provoke palpitations. 

Caffeine and Palpitations

Palpitations are usually the number one sign I use to tell if patients are consuming too much caffeine. There are so many different factors with caffeine intake which determine how you’ll respond to it. Some of these factors are: 1) amount of caffeine consumed, 2) how quickly the caffeine was consumed, 3) if the caffeine was consumed on an empty stomach, 4) if the person is hypoglycemic, 5) the size of the person, 6) how well your liver metabolizes caffeine.  Some people can drink 3 Large cups each days and be completely fine, and others can’t even drink 1 small or they’ll start getting palpitations and anxiety. I have some patients who think they are better off because they’re drinking a small espresso, but espressos pack a lot of caffeine and they’re consumed much faster than a large coffee. It’s much safer to drag the caffeine consumption out over a couple of hours rather than a couple minutes. Check out myarticle on caffeine and arginine to see why preworkouts are dangerous. 

Calcium Deficiency and Palpitations

Clinically, magnesium seems to be a more common cause of palpitations but I have had some patients whose palpitations didn’t go away until they started taking a calcium supplement. These patients seem to have their palpitations mainly at night and they usually have other calcium deficiency symptoms like tingling of the face, muscle spasms or cramps, and brittle nails. Too much calcium can also cause palpitations since calcium depletes magnesium. 

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Vitamin D Deficiency and Palpitations

​Vitamin D influences calcium and magnesium levels so it only makes sense that a deficiency in this vitamin can also contribute to palpitations. 

Hyperthyroidism and Palpitations

The thyroid controls your metabolism. If it’s overactive it’s going to speed everything up including your heart rate. Anxiety and panic attacks are also a common symptom of hyperthyroidism. I’ve had many anxiety/panic attack patients who were undiagnosed for a good part of their life but once we tested their TSH and anti-thyroglobulin, they were diagnosed with Graves disease. Once their Graves disease was controlled the palpitations went away. 

Too Much Iodine and Palpitations

​Iodine stimulates the thyroid. Too much of anything can be a bad thing. If you’re consuming too much iodine, kelp, seafood, etc… you could temporarily put your thyroid into a hyperthyroid state and cause palpitations to occur. This is rare but I have seen it clinically. 

Stimulants and Palpitations

Any stimulants you consume have the potential to cause palpitations. These stimulants are synthetic stressors and put us into fight or flight mode. Some examples of stimulants are caffeine, anti-depressants, Ephedrine, nicotine, amphetamines, ADHD drugs like Ritalin and Adderall, MDMA. Most people know if they’re taking a stimulant but others are surprised to hear that pre-workouts, cough syrups, decongestants, anti-depressants, ADHD medications and weight-loss supplements are all likely to contain stimulants.

High Blood Pressure and Palpitations

​If blood pressure gets very high or if it’s been fairly high for an extended amount of time you can start to experience palpitations. Sometimes magnesium is used to bring the blood pressure down and subsequently reduce palpitations. 

Low Blood Pressure and Palpitations

In my experience once blood pressure gets below 90/60mmHg, palpitations happen frequently. These patients who have such low blood pressure tend to have low iron status as well, so once iron status improves the blood pressure comes up a little bit and the palpitations sometimes resolve. 

Medications and Palpitations

​Different medications can cause palpitations for various reasons. Stimulants will cause them by stimulating the nervous system. Thyroid medications, GERD medications (acid blockers), blood pressure meds, steroids, any many other drugs can deplete magnesium and/or calcium which can eventually lead to palpitations as well.

Alcohol and Palpitations

Binge-drinking and long-term use of alcohol can deplete several different nutrients which can lead to palpitations, especially if these nutrients are not being replaced via supplementation. If alcohol is combined with energy drinks they can also cause palpitations due to their stimulant effect. 

Heart Issues and Palpitations

As you may have noticed, there are several less-serious causes of palpitations. There are many different heart conditions like atrial fibrillation, murmurs, abnormal rhythms, heart defects, etc… that will also cause palpitations. This is why it is important to consult with your doctor and work with a professional. Most patients who come in don’t think anything of their palpitations, but it can either give me a hint about what is going on or warrant further investigation. Usually patients will tell their MD about their palpitations and I work with them while they’re waiting for the cardiologist appointment to rule out the causes listed above. 

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Sincerely, Dr Justin Gallant ND
Hamilton, Ontario