@miffli I've been reading and rereading your posts in this thread. I don't feel I know you well enough to help you, so I'm going to lay out what I do know...
The three minerals that are depleted with the keto diet are sodium, potassium, and magnesium.
According to an article from the American Heart Association, pink Himalayan salt has 1700 mg sodium per teaspoon; sea salt has 2000 mg sodium per teaspoon; and table salt has 2300 mg sodium per teaspoon.
To get the equivalent of 2300 mg sodium in table salt, you'd need about 1.35 teaspoons of pink Himalayan salt to equal 2295 mg of table salt.
Here's what one of the leading researchers on the ketogenic diet recommends for sodium intake...
"How much sodium, potassium and magnesium should I have on a ketogenic diet?
By Dr. Stephen Phinney and the Virta Team
In short, 3000-5000 mg of sodium and 3000-4000 mg of potassium on average are needed as part of a well-formulated ketogenic diet. For sodium and potassium (aka electrolytes), rather than trying to track them directly (which is frustrating at best), we recommend salting food to taste, adding 2 grams of sodium as broth or bouillon, and eating 5 servings of non-starchy vegetables daily. For magnesium, 300-500 mg is an initial recommendation. Muscle cramps are our best indicator of depletion, and to replenish one’s intracellular magnesium, we generally recommend 3 tabs per day of Slow-Mag or the generic slow-release equivalent for 3-6 weeks."
Link:
https://blog.virtahealth.com/sodium-potassium-magnesium-ketogenic-diet/
What he's saying is to take 2000 mg of sodium in addition to salting all your foods to taste. I personally have never had to take that much, perhaps because I'm not an athlete and not particularly physically active other than walking every day or every other day. That said, when I'm having keto flu symptoms, I do take additional sodium.
Potassium is trickier. I don't think I've ever met the minimum requirement for potassium. Interestingly, animal protein is also a good source of potassium:
3.5 oz beef...315 mg potassium
3.5 oz pork...420 mg potassium
3.5 oz chicken...221 mg potassium
3.5 oz salmon...361 mg potassium
3 oz tuna...201 mg potassium
1 egg, whole, cooked...67.6 mg potassium
Other keto friendly sources of potassium:
1/2 avocado...487 mg potassium
spinach, frozen, 1 cup...540 mg potassium
spinach, fresh, 3 cups...501 mg potassium
swiss chard, fresh, 3 cups...408 mg potassium
Brussels sprouts, cooked, 1 cup, 494 mg potassium
white button mushrooms, raw, 1 cup...223 mg potassium
zucchini (corgette), raw, 1 cup...325 mg potassium
Medications on the keto diet
It's good your doctor took you off the empagliflozine due to the possibility of ketoacidosis on the keto diet. Blood pressure medications may need to be adjusted too. If you have a way to regularly check your blood pressure, that could be helpful so you can inform your doctor if you notice a change.
Written for physicians from DietDoctor.com:
"Carbohydrate restriction is an effective way to lower blood pressure. However, the change happens more slowly than the change in blood sugar, potentially occurring within days or months. Therefore, you do not have to automatically adjust blood pressure medications as you need to with glucose-lowering medications.
Instead, this is something to assess during the follow-up. Start by making sure your patient is aware of potential symptoms of hypotension (such as experiencing dizziness, fatigue, or nausea) and knows to contact you immediately if they occur."
What can happen in the morning when your body thinks you don't have enough glucose during the first month or so on the ketogenic diet
After I started the keto diet and my glucose levels began coming down. If I didn't eat as soon as I got up, I'd sometimes become very shaky and distressed, and it came on suddenly without warning. It felt like I was having a hypo, but when I checked my blood glucose level it wasn't low at all. This is called a "false hypo" and it can be very distressing.
Read more about it here from Jenny Ruhl's website...
"Why Do I Feel Shaky and "Hypo" When I Achieve Normal Blood Sugars?
If you have had high blood sugars for a while--even only moderately high blood sugars--when you start lowering your post-meal blood sugars you may find that you feel shaky and even downright sick. This can happen even before you bring your blood sugars down into the normal range.
This is because over time, your body has become accustomed to those much higher blood sugars and it interprets the normal blood sugar as being dangerously low. When this happens, the body secretes fight or flight hormones in order to push the blood sugars back up to what it erroneously thinks is the safe zone. This phenomenon is called a "false hypo."
The stress hormones associated with this counter-regulatory response can make you feel dreadful. However, if you test your blood sugar during a false hypo, you will see that it is not below the 70 mg/dl (3.8 mmol/L) level that defines the beginning of the mild hypo range. That is why it is very important to test your blood sugar when you feel hypo. If you are not using insulin or one of the pills that stimulate insulin secretion you should only treat a hypo when it is a true hypo below 70 mg/dl. With higher "lows" your body will recover on its own.
The symptoms you feel during a false hypo may include a pounding pulse, shakiness, a raised blood pressure and other symptoms very similar to those of a panic attack. (NOTE: If you are using insulin or an oral drug that causes increased insulin secretion you should treat hypos below 80 mg/dl (4.4 mmol/L) because it is always possible that the drug will continue to lower your blood sugar to an unsafe level.)
After a experiencing this kind of counter-regulatory response you may feel shaky for another hour or two, because of the changes the stress hormones have made in your body. You may also become a bit more insulin resistant than usual. But after some period of time which varies from person to person, your body will get used to these new, normal blood sugars and you will only develop hypo symptoms when you are having a true hypo, which, if you are controlling using diet alone, should almost never happen.
So no matter what you feel when you first reach normal levels, try to wait it out. Your body is getting all the glucose it needs when your blood sugar is above 70 mg/dl (3.8 mmol/L). Doctors do not consider true hypoglycemia (low blood sugar) to begin until under 70 mg/dl (3.9 mmol/L). It does not become dangerous until it reaches levels like 45 mg/dl (2.5 mmol/L).
If your blood sugar has been very high for a while, you can make the adaptation process a bit easier by proceeding in stages, setting your blood sugar targets progressively lower, a step at a time. But don't stay at higher than normal levels for any longer than is absolutely necessary. Once your body does adapt, you will probably feel much better and much more energetic than before.
So be patient while your body becomes accustomed to new, healthy, blood sugar levels. Don't respond to feeling as if you were having a hypo by eating carbs to push up your blood sugar as long as your blood sugar tests at 70 mg/dl (3.9 mmol/L) or above if controlling with diet alone or 80 mg/dl (4.4 mmol/L) if using insulin or an insulin stimulating drug. Give your body a chance to adapt and eventually you will feel completely normal when you have a normal blood sugar and may feel surprisingly toxic when your blood sugar reaches the dangerously high levels at which you used to feel normal at."
Link - (you'll have to scroll down to the section)...
https://www.bloodsugar101.com/healthy-blood-sugar-targets
Three more thoughts...
As some have already pointed out, it may take days to a week for the effects of the medication you stopped taking to ease, so give it some more time.
When you feel energized, you could be having a false hypo as described above.
When you feel low energy, you could be experiencing "keto flu" due to not getting enough sodium each day. If that's the case, see how you feel after you've had some sodium.
- OR -
You could be having a hypotensive episode. The only way to know is to check your blood pressure.
Hope this gives you the information you need to continue sorting out what is happening to you.
.
