It is no secret the supplement industry is booming. In fact, it has been booming for several decades. I remember that as a young mother—by now over 30 years ago—I would be quite concerned about my children getting the proper amount of vitamins and minerals and used the typical children’s gummies and similar to supplement whatever a “good mom was supposed to do” and never ever questioned if any of that was really necessary.
With hindsight, given that the kind of nutrition a “good mom” was supposed to serve her children was made up mostly of sweetened cereal, fruit juices, plenty of chicken noodle soups, mac and cheese, peanut butter and jelly sandwiches on good old Wonder bread, and burgers, supplementing with vitamins and minerals was indeed the best thing to do.
Moms today may still feed their children the same junk SAD (Standard American Diet), now amended by soft drinks and plenty of candy. So for some people, supplementation is essential. However, some minerals should never be supplemented, and potassium is one of them. In this article I hope to open many eyes.
Potassium
While there are many vitamins and minerals I could have picked for this discussion—and I may discuss some of the others in later blogs—here I focus on potassium. My reason for doing so is because this mineral is likely the least understood and the most misused. Hardly a day goes by without someone proudly telling me that they supplement potassium. Similarly, hardly a day goes by when I am not attacked when I explain they probably should not be supplementing potassium. Clearly, there is a gap between scientific knowledge and public belief, and this chasm can be harmful.
In order to be sure I provide the proper explanation, I have contacted an emergency cardiac surgeon friend by email, whom I have known for a couple of years. I asked several questions about potassium and its use in the hospital. My comments and explanation to the answers he gave are started with *** so you can distinguish my thoughts on his answers. I use square brackets in some places that provide explanation of a few terms used by the doctor and to replace medical jargon for clarity.
Questions and Answers about Potassium
Dear M, I have been studying potassium for some time. I would like to ask you to help me clarify a few things. Many people supplement potassium and I always tell them to stop. I believe that potassium supplementation is harmful—particularly by the general public that knows nothing about the side effects.
Q: What is potassium?
A: K [Potassium] is an intracellular ion that shifts with pH [acidity level]. So we look for the underlying cause: if [potassium] is elevated – acidosis, renal failure; if [potassium] is reduced – alkalosis. [Potassium] supplements can be potentially harmful in the setting of impaired elimination (renal failure, acidosis) but within reasonable dosing they should not be.
***Potassium is important in our diet—a mineral that is necessary in our electrolyte. If we look at the USDA recommendation for potassium, we find that the RDA is age and gender dependent. For adult males it is 3400 mg a day and 2600 mg for females. How much is 3400 mg potassium? Hmmmmm great question. According to the USDA database, 100 gr (3.5 oz) of a California avocado has 507 mg potassium, 100 gr Florida avocado 351 mg, 100 gr wild Atlantic salmon has 490 gr, 100 gr rib eye steak has 305 gr, 100 gr baked russet potato with skin has 550 gr, and a glass (8 oz) of whole milk has 322 mg potassium. This should give you a good idea of what it takes to incorporate a high potassium diet into your life.
In contrast to the USDA RDA, this is what the Mayo Clinic suggests:
“Because lack of potassium is rare, there is no RDA or RNI for this mineral. However, it is thought that 1600 to 2000 mg (40 to 50 milliequivalents [mEq]) per day for adults is adequate”, which you can find here.
Of course, food sources are not the only means by which you can take potassium. There are potassium supplements and foods that are enriched with added potassium; those are also considered supplements.
Q: In the ER setting, do you (by you I mean your facility) ever give potassium to a patient?
A: Yes. If they are low [in potassium] by IV [intravenous solution] or PO [taken as pill]. IV if we hydrate with Normal Saline (NS), we add 20 mEq of KCL [potassium chloride] per liter on NS plus lidocaine [a medication that is used as anesthetic and also as an anti-arrhythmic] because potassium burns veins.
***20 mEq of KCL is approximately 800 mg potassium equivalent in pill.
***Note that lidocaine is an antiarrhythmic medicine. This will become important as you continue reading.
Q: If it is supplemented, why so?
A: Because if they are truly low, because of chronic use of diuretics, they need [potassium] replacement. They can be falsely low because of intracellular shifts caused by alkalosis (respiratory or metabolic). Then we try to fix the underlying cause. [Potassium] is not to treat hypertension but to replace [potassium] washed out by diuretics used for treatment of hypertension: furosemide and HCTZ (Hydrochlorothiazide) in particular.
***Looking at it logically, if A > B and if B > C, then A > C. Thus, when anti-diuretics are given for hypertension, they always wash potassium out to such extent that potassium has to be replaced, therefore potassium is given in the treatment of hypertension.
You may want to listen to this podcast with Dr. Paul Saladino. While the discussion is not about hypertension, at about the 40-minute mark, Saladino discusses the importance of salt and problems with supplementing potassium. He says—and this is true—that the FDA limits potassium supplements to be <100 mg because of the often serious side effects. Some of the side effects are vomiting, nausea, upset stomach, gas, diarrhea, and tingling in the hands or feet. Hyperkalemia can also cause serious heart arrhythmias (hyperkalemia is too much potassium). In spite of the FDA regulations, while most supplement providers do only provide 99 mg potassium per serving as supplemental potassium, not all do. This link takes you to one company that disobeys the FDA rules. So be careful about what you purchase.
Q: Is it ever considered in the ER that potassium may cause heart arrhythmia?
A: But of course. Hyperkalemia is a true emergency. It causes VT [ventricular tachycardia]. We fight it with insulin and glucose, calcium gluconate to stabilize cardiac membranes etc. albuterol, hydroxylate
***I found this answer extremely interesting and important. Calcium is the main mineral that is necessary for the heart to beat, hydroxylate to provide a hydroxylation chemical reaction that increases the pH, which results in a temporary potassium shift from the extracellular to the intracellular environment, pulling potassium out of the blood; insulin and glucose for heart, which allows the heart to quickly uptake glucose, causes an intracellular shift of potassium because glucose entering the cells causes a sodium and water efflux, thereby potassium floods into the cell(1) and this too pulls potassium out of the blood and into the cells. Albuterol (β2-adrenergic agonists, same as epinephrine) is also used for asthma. It too induces cellular reuptake of potassium by the release of epinephrine—meaning, it too pulls potassium out of the blood and into the cells. This is how much work and medicines are required to overcome hyperkalemia, which can cause heart failure and death.
I was particularly surprised by the need for insulin administration, but a renal physiology book explained the many connections between insulin and potassium. Interestingly, treatment with insulin is sometimes necessary and not just from supplementation but also as a result of a potassium-rich meal, which can cause hyperkalemia in some populations:
“The importance of insulin is illustrated by two observations. First, the rise in plasma [potassium] after a [potassium]-rich meal is greater in patients with diabetes mellitus… than in healthy people. Second, insulin (and glucose to prevent insulin-induced hypoglycemia) can be infused to correct hyperkalemia. Insulin is the most important hormone that shifts [potassium] into cells after the ingestion of [potassium]… Aldosterone, like catecholamines and insulin, also promotes [potassium] uptake into cells. A rise in aldosterone levels (e.g., primary aldosteronism) causes hypokalemia [too low potassium], whereas a fall in aldosterone levels (e.g., in persons with Addison disease) causes hyperkalemia… aldosterone also stimulates urinary [potassium] excretion. Thus aldosterone alters the plasma [potassium] by acting on [potassium] uptake into cells and by altering urinary [potassium] excretion”(2)
This implies, that supplementing potassium by a person with type 2 diabetes (T2D) has more serious consequences than for a metabolically healthy person. For a person with T2D, even a high-potassium meal may cause hyperkalemia, requiring serious countermeasures. It also means that people with reduced adrenaline or cortisol (the so called “adrenal fatigue”) may have high potassium. Both of these conditions are adrenal disorders. One way to regulate high potassium is by increasing sodium in the diet—this explains the salt cravings of those with adrenal insufficiency (aka adrenal fatigue). This electrolyte disturbance is represented by salt wasting and potassium sparing in the body, which can be remedied by the consumption of excess salt.
Q: A reduced sodium diet will necessarily reduce potassium (by the RAAS system) and will cause problems. Would it not make more sense to increase sodium in order for the kidneys to retain more potassium? I mean, a homeostatic balance (osmolality homeostasis) must always be achieved, so a reduced sodium diet, by default, should be causing problems with potassium.
A: A reduced sodium activates RAAS [Renin–angiotensin system] to retain sodium by exchanging it for potassium in proximal tubules [in the kidneys]. Osmolality is addressed by pituitary ADH [antidiuretic hormone, such as vasopressin] in distal tubules [in the kidneys].
***So let’s take this answer apart:
- “reduced sodium activates RAAS to retain sodium” because of the osmolality of the electrolyte, discussed in the next point, must remain constant. This is an important point here that is relevant in reduced sodium diets that are recommended for the general population and particularly for those with hypertension. However, if reduced dietary sodium initiates the body’s safety system to retain sodium, then does a reduced sodium diet make sense for hypertension? It appears to achieve the opposite: reduced sodium diet increases blood pressure as a result of the RAAS system.
- “by exchanging potassium for sodium in proximal tubules” in the kidneys means that a reduced sodium diet reduces potassium from the blood.
- “osmolality is addressed by pituitary ADH in distal tubules”—this refers to water sparing (retaining) or wasting (eliminating), depending on the circumstance. In order to keep the correct balance (osmolality) between sodium, potassium, and water, in addition to wasting excess potassium, water volume will also be reduced in order to retain sodium and increase its relative density, re-establishing homeostasis.
All in all, a reduced sodium diet prevents the elimination of sodium. Potassium is eliminated as sodium is retained. This is the opposite of the desired outcome of a reduced sodium diet. Because of the careful balancing of the RAAS and ADH systems, a diet with excess potassium will necessarily lead to reduced potassium, increased sodium, and reduced water volume. In other words, the body controls for minerals by releasing extra amounts, retaining those in too small amount, and by reducing water in order to retain the osmolality homeostasis.
Supplemental Potassium
The main function of the supplemented potassium, according to the ER doctor above, is to work with diuretics that reduce blood pressure, and also reduce potassium in the electrolyte. However, if one is not taking a diuretic and has no high blood pressure, what does supplemental potassium do? Unlike potassium that is consumed in food, and which – together with sodium – becomes part of electrolyte slowly, potassium that is supplemented absorbs at once in large quantity and can negatively affect the heart and the muscles.
A sudden increase of potassium in supplemental form is a medical emergency for the body. The renal function will handle it the following way: Our kidneys are in charge of the osmolality of blood plasma. Plasma osmolality refers to our electrolyte water balance between its solute (particles and elements dissolved) concentration and the volume of solvent (the liquid in which something is dissolved). Of course, in this case the solvent is water, and the solutes are all the electrolyte minerals that are in the water and form the plasma electrolyte fluid.
When the plasma suddenly contains more potassium than it does in homeostasis, the kidneys have to change the other solute amounts to neutralize the excess potassium to ideal osmolality. The ideal osmolality is between 275 and 295 milliosmoles per kilogram (mOsm/kg) and if this is increased as a result of the extra potassium, a critical renal task is to change it back to homeostasis. The kidneys now will waste (urinate out) potassium and water but retain sodium. This helps regain the same concentration of homeostasis before the arrival of extra potassium—with one caveat. Since the kidneys waste water and potassium, the blood volume changes: it is reduced. Reduced blood volume is indicative of dehydration similarly to a diuretic action.
Although technically potassium is not a diuretic, because supplemented potassium reduces blood volume, it is equivalent in its outcome to having taken a diuretic.
Should You Ever Supplement Potassium?
Probably not, as it can be harmful. Many people drink lots of potassium-rich drinks, such as sport drinks, juices, and green smoothies. Drinking potassium-rich electrolyte during exercise may be harmful. Studies show that during heavy exercise potassium levels increase in the blood naturally as muscles release more potassium. The function of potassium at the potassium/sodium pumps is to operate the electrical activities of the cells. When potassium rushes out of the cells, as it does during heavy exercise, this is a sign that sodium has rushed into the cells. When sodium rushes into the cells, the cell is generating an action potential—an electrical activity. It goes without saying that exercise increases electrical activity in cells, and as such, there will be more potassium in the blood, outside of the cells and more sodium inside of them. Even without supplementing potassium during an exercise, hyperkalemia, caused by the exercise itself, has claimed victims not infrequently in the past. Taking additional potassium increases potassium in the blood, causing hyperkalemia, which can be fatal, even from Low-sodium salt alternatives(3,4). Morton’s Lite-Salt contains 50% less sodium than regular salt, and incorporates 350 mg potassium per ¼ teaspoon salt–over 3.5 times RDA maximum for supplemented potassium per quarter teaspoon.
It is also understood—based on these principles—that potassium induces resting potential and is responsible for feeling fatigued during intense exercise.
Conclusion
Nothing beats a healthy diet full of macro and micro nutrients. Although our modern food environment is not as healthy as it should be and we are at risk of potentially missing some minerals or vitamins from our diet, we must consider what the nutrients we wish to supplement will actually do in the body and how. Potassium is not a mineral to supplement without medical prescription and supervision. It may cause more harm than good. If you wish to increase potassium in your diet, eat whole foods and avoid processed foods. It is that simple.
Please consult your physician before making changes to your supplement regimen.
References
- Longo, D. L. et al. Harrison’s Manual of Medicine 18th Edition. (McGraw Hill Medical, 2013).
- Koeppen, B. M. & Stanton, B. A. in Renal Physiology (Fifth Edition) (eds Bruce M. Koeppen & Bruce A. Stanton) 115-130 (Mosby, 2013).
- Hultgren, H. N., Swenson, R. & Wettach, G. Cardiac arrest due to oral potassium administration. The American Journal of Medicine 58, 139-142, doi:10.1016/0002-9343(75)90545-8 (1975).
- Restuccio, A. Fatal hyperkalemia from a salt substitute. The American Journal of Emergency Medicine 10, 171-173, doi:10.1016/0735-6757(92)90058-6 (1992).
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Angela, please, what if someone does not know supplement potassium with food?
Erika,
I am not sure what you mean? Nearly all food has potassium in it. You can look up the amount of potassium in the food you eat at the USDA website here and type in the name of the food. For example, most people think that meat has no potassium. So here are a few examples for you, selecting 100 gr (3.5 oz) which is smaller than what people usually eat in one meal, but will give you a good example:
Beef chuck for stew has 359 mg potassium
Sockeye salmon: 367 mg
Chicken legs and thighs (without bone): 244 mg
Pork shoulder (butt) roast: 318 mg
I only selected animal products here because nearly all plants have potassium and most people think that only plants have potassium, but meats do as well. So there is no need to supplement potassium. If you eat whole foods, especially if you cook them from scratch, you get all the potassium you need.
Angela
When I tried sodium and it didn’t work, I can’t bring myself to try food with potassium because it makes me sick to my stomach and I throw up any food
Erika I am not sure what “it didn’t work” means. I don’t know what way you eat, and don’t know what foods you are eating for potassium and why.
Are you talking about migraines? If yes, please join my Facebook migraine group and ask your questions there.
Angela
This is so fascinating.
I’ve been doing a migraine protocol where at the onset of a migraine, I drink 14 oz or coconut water (natural electrolytes), the juice of 1/2 a lime and the entire glass is thickly rimmed with salt, which is all consumed/eaten while drinking this migraine cocktail. This is taken with 400 mg of Magnesium Glycinate. I read this in an article (it actually recommended 1000 mg Magnesium), and the idea is to mimic an IV.
It has worked for me about 90+% of the time to stop my migraine in its tracks. I’ve been absolutely astonished as there was a time that I was getting 5+ migraines per week and now I’ve been pretty successfully avoiding them altogether doing this.
I assumed it was the electrolyte balance after reading some research on a possible link between migraines and electrolytes. Now reading your article, I am wondering if this would be considered “supplementing” with potassium. I’m never fond of taking synthetic forms of anything… so the potassium in the coconut water is naturally occurring in the food (i.e. The pressed coconut) itself.
One last question. I just looked and my salt is “Morton Iodized Sea Salt”. I was told that since we only cook with sea salt, we should try to find a form that is iodized. On the back it says it contains “potassium iodide”. Is this also considered a form of potassium? Should I “do away” with this and go back to just plain sea salt? I am clearly not well versed in the elements. ?
Your article has me worried now.
Dear Migraineur,
Coconut water is natural potassium, not supplement. However, it has lots of carbs in it, and is usually not recommended, unless there are no alternatives, like avocado, steak, or salmon–all high in potassium.
In terms of the need for potassium: none. Migraine is an electrolyte imbalance and what you really need is sodium. Your kidneys excrete the excess potassium, so you are alright, but it’s not optimal, since you get dehydrated doing that. We have more than enough potassium. In our body there is more sodium than potassium. I know the USDA recommends higher potassium but that’s quite incorrect. Next time, when you get your blood test, check the “Electrolyte Panel” ideal ranges.
POTASSIUM 3.5-5.0 mEq/L
SODIUM 135-145 mEq/L
Note how much more sodium is in the blood than potassium! Drinking potassium gets the potassium into your blood, causing a medical emergency each time. It will be OK while you have good kidneys but not later.
Potassium iodide is a form of iodine.
For salt: in our body everything breaks into its ions, so salt is sodium and chloride. Anything else taken with it separates and heads to wherever. All salt type are from the sea, so there is no salt that is not sea salt. Even the most common table salt is sea salt. The difference is that it is heated to purify. Other fancy sea salts are evaporated. Have you ever seen how that is done? Once you have, you will never want to touch it again. From the people who work on it spitting into it to the bird flying over and pooping into it, all dead fish and other organic materials are all on it. These collectively for all the “minerals”. So no thanks. I recommend you stick with purified table salt with iodine. If you don’t want to take synthetic iodine, get kelp in capsules. Great iodine supplement.
Angela
Although you raise some valid concerns of taking too much potassium in one single dose, it seems like you overstate the problem. According to Dr. Chris Masterjohn, there have been studies where up to 15 grams of supplemental potassium a day were given, with no ill effects. He also says our ancestors probably got somewhere between 10 and 12 grams a day in the diet. Now yes, getting it from food is different from getting it in supplement form, but I’d say unless you have compromised kidney function, these concerns would apply to a small segment of people. Also, you say you probably shouldn’t supplement with potassium because it “can be harmful.” How many common medications do you and other doctors prescribe that would have a much higher chance of causing harm to a patient than getting some extra potassium? Too much of anything can be harmful, even water. But excluding potassium, a much needed nutrient, simply because high doses could POSSIBLY cause a problem, seems a bit overboard, especially since the majority of Americans diets are horrendous, and they probably need some extra to compensate.
Dear Jason,
What our ancestors ate is just a bunch of guessing since there is even a disagreement over what they ate let alone how much potassium they consumed in what they ate.
What we do know for certain is that by atomic measures, there are more sodium ions in us than potassium, but since potassium is larger in size, by weight potassium to sodium in the human body is 1:1.
Atomic Composition of a Lean 70-kg Man:
Element # of Atoms (I copied out only those most of us are familiar with)
hydrogen 4.22 x 10^27
oxygen 1.61 x 10^27
carbon 8.03 x 10^26
nitrogen 3.9 x 10^25
calcium 1.6 x 10^25
phosphorus 9.6 x 10^24
sulfur 2.6 x 10^24
sodium 2.5 x 10^24
potassium 2.2 x 10^24
chlorine 1.6 x 10^24
magnesium 4.7 x 10^23
silicon 3.9 x 10^23
fluorine 8.3 x 10^22
iron 4.5 x 10^22
zinc 2.1 x 10^22
manganese 1 x 10^20
…
iodine 5 x 10^19
…
chromium 6 x 10^18
molybdenum 3 x 10^18
selenium 3 x 10^18…
So you can see in the table above that we have more sodium atoms in us than potassium but by weight they are about the same.
So if ancient humans ate 10-12 gr potassium a day then they also ate 10-12 gr sodium a day, and since sodium is 40% of salt, this equates to 25-30 gr salt. One teaspoon salt is 2400 mg, or 2.4 gr salt. so they would have had to have eaten, on any average day, between 10.42 and 12.5 teaspoon salt equivalent. Since they obviously didn’t do anything like that, guessing is lovely but quite pointless.
Electrolyte Dynamics:
Since you brought it up, let me explain something important. Since potassium is mostly inside our cells and sodium is mostly outside of the cells, the dynamics aren’t as simple as you describe. Check your electrolyte panel from your last blood test, and you will see that in the blood the ideal potassium level is 3.5-5.0 mEq/L and the ideal sodium level is 135-145 mEq/L. What this shows you is that there is 27-42 times as much sodium in the blood as potassium at any given time in a healthy person. If you supplement electrolytes, they are ions, and they get into the blood instantly. If you increase the blood sodium by 5 mEq/L, it’s no big deal! 135+5 is 140 mEq/L and you are still within the normal range. Now, let’s increase the potassium by the same 5 mEq/L and with that we jumped from 3.5 to 8.5 mEq/L and that’s almost double the maximum of 5 mEq/L that is still healthy.
So there is a difference in how the two electrolyte ions should enter the body because supplementing potassium dumps it in the blood and that can harm/kill the person. If potassium is consumed in the food, it is absorbed through the intestines and slowly, and so we don’t face the problem of having so much in the blood all at once. Because having a 5 mEq/L potassium increase in the blood is extremely difficult to reduce–this is explained in my article–and may also be fatal, we face a complication. To get potassium out of the blood and into the cells, we need to force sodium and water out of the cells–this is because they both are positively charged ions and they repel each other. In addition, the cells are full, it’s not like there is room inside the cells. So in order for potassium to enter the cells, something must come out in equal amount–this is just pure physics And for that doctors use intravenous glucose and insulin! And that’s because glucose literally kicks sodium and water out of the cells and so as sodium comes out, potassium can go in. If the potassium cannot disappear from the blood, it may lead to death–we use potassium injection at executions for this reason. It causes a fatal heart arrhythmia.
The Role of the Kidneys:
Let me also discuss the role of the kidneys here since it is extremely important. The kidneys cycle the blood through 5 times and hour, so every 12 minutes or so, your blood is set back to normal electrolyte ranges. provided the differences from this normal are not too great! The kidneys can use the RAAS (renin-angiotensin-aldosterone-system) to help retain sodium in case there isn’t enough sodium consumed, and it will recycle it. When one eats too much potassium and the blood is high in potassium (hyperkalamia), the system changes.
So as you can see, while the kidneys can deal directly with the excess sodium, they cannot with the excess potassium, and this causes a problem, because of aldosterone. Too much aldosterone (a hormone) can make one lose potassium and retain sodium. This causes an imbalance in which the body holds onto too much water, increasing blood volume and blood pressure. So too much potassium can actually increase blood pressure, whereas lots of sodium can actually reduce it. If you haven’t yet watched this video, I highly recommend that you do.
Best wishes,
Angela
This is without a doubt the lowest quality article I’ve found on your otherwise excellent site. The author does not understand the basic mechanisms she is trying to explain here.
Her perspective and sources:
1) By interviewing ER medics and cardiac surgeons she managed to find the two professions that HAVE to obsess the most about potassium AND think the absolute LEAST about long term consequences for their patients.
2) It’s uncommon to even assess intercellular potassium levels in either profession, they simply tweak the tiny extracellular potassium quantity in a variety of ways to avoid patients dropping dead while on the table.
3) They deal with patients AFTER the brunt of the damage is done and they prescribe medication made by companies that wants sales, and manufacture the science needed to sell.
4) You got edema, doc got a diuretic, never mind that edema is caused by electrolyte loss which that diuretic will exacerbate, doc has a few 99mg KCL for that too ?
Cause and effect:
1) Low potassium intake over decades is very likely to cause reduced kidney function to such a degree that patients get sick (for direct and indirect reasons) and end up in the ER and on the surgeons table, at which point potassium is a whole lot less likely to be effectively managed by they kidneys and THEN it becomes dangerous to supplement. Low potassium can and does fuel the number of bodies on that table and once they get there high potassium becomes a serious concern.
2) Serum potassium increase during exercise is caused by reduced kidney function in ill people or severe preexisting electrolyte imbalances and the number of people that die from it is absolutely microscopic compared to the number of people harmed by low potassium over decades.
3) Potassium supplements in pill form are limited to 99mg because it’s a horrible way to supplement potassium for the gut and ulcers are a frequent result. The problem is the pill form supplement, and NOT the notion of supplementation.
4) T2D patients are very very likely to have wasted a LOT of potassium over decades for a number of reasons, edema being an obvious sign but far from the only one. That wasting causes early loss of kidney function in T2D patients in a variety of ways and the only reason why it becomes sketchy to supplement for them is when it’s too damn late and their kidneys are hanging on to their last nephrons. It makes sense to be weary of potassium supplementation once the kidneys are done, but a large part of what wrecked those kidneys was that potassium was too low in the first place.
With all that said I agree that pill form potassium is a bad idea, but we have been drinking potassium rich water since we walked on 4 legs and only stopped doing it ~80 years ago. If your water does not have a sensible potassium content (mineral water) it makes all the sense in the world to add some and it’s easy enough to buy potassium chloride/bicarbonate powder from amazon or a mineral water manufacturer. Unless you have been following the horrible advice above and wrecked your kidneys already.
Dear S.R.,
It appears that you are writing solely based on your experience and nothing scientific. I respond to each of your points in brief, since there is no point of arguing with you. Here are responses to the first set of your points:
1) The reason why doctors look at potassium in the blood is because it is an easy measure of what is available to be inside the cells if the cells need it. Since cells can only take in potassium when sodium is coming out, the consumption of potassium and the increase of potassium in the blood is not going to get potassium into the cells. To get potassium into the cells is done by the cells themselves by their respiratory functions. Eating/drinking/supplementing extra potassium will not be able to increase potassium in the cells if there is sufficient amount in there or if there isn’t enough sodium to come out of there.
2) The priority in the ER is to prevent people from dropping dead. And, as I noted in point 1), they cannot place potassium into cells without forcing sodium out of it.
3) Of course they deal with the patients after they are ill… it is an emergency room I described
4) Edema is not caused by electrolyte “loss” but displacement. The fluid is still in the body and is not lost.
In terms of the cause and effect you describe, again, point by point to your second set of points:
1) “Low potassium intake over decades”… assumptions cannot lead to cause and effect–they can just lead to predictions based on assumption, which may be totally false.
2) “Serum potassium increase during exercise is caused by reduced kidney function” no, serum potassium increase in athletes is caused by eating a lot of gels during the workout and also because the cells use higher rate of respiration to keep up with the muscles. They also lose lots of sodium and water from perspiration but not potassium.
3) Potassium supplementation in a pill form doesn’t reach the intestines but ends up in the blood, where it shouldn’t be. Potassium from food reaches the intestines where it can absorb into cells slowly, at the rate of which the cells wish.
4) In people with T2D the loss of kidney function is caused by the much glucose in their blood and the loss of both sodium and potassium as a result of the massive amounts of drugs they are on that artificially keep blood glucose low. Low sodium can cause insulin resistance and insulin resistance is a level of type 2 diabetes. The reason why this happens is becuase glucose needs transporters to get into the cells. The human body has two forms of transporters for glucose: sodium and insulin. Insulin transport is used to deliver glucose to the skeletal muscles and sodium transporters are used for the brain and other organs. And as glucose enter the cells, sodium and water is pressed out of the cells. So in T2D the person actually loses massive amounts of sodium, in addition to insulin hoarding sodium. Potassium is expelled by the kidneys because of the reduced sodium in the blood. The RAAS system kicks in when there is low sodium levels in the blood and the kidneys are forced to spare (recycle) sodium and waste potassium.
In sum: going by the example of one person has never been a great idea. Your assumptions are quite incorrect. And no, my kidneys are extremely healthy and I am not too far from your age.
An article you can read at your leisure: low-salt (low-salt is potassium chloride, often used to increase potassium and reduce sodium).
Angela
Hi Angela, Do the same rules follow for people with POTS? When I don’t supplement with potassium I get a myriad of symptoms, including weak muscles, insomnia, twitching, svt and increase in POTS symptoms.
I do take magnesium and salt every day.
I am on a carnivore diet and take a lot of supplements because of low stomach acid and an EDS protocol. These supplements tax potassium levels.
I’m no sure what I should do?
Hi Jonelle,
POTS is a condition in which you need to increase your salt tremendously in order to keep enough of a blood pressure to get the blood into your head. POTS is a condition in which the little valves that prevent the blood from falling to your feet either don’t exist or don’t work, and hence the blood pools into your feet, causing a high blood pressure in the feet and legs upon standing and a low in the head.
So, armed with this information, I am unclear where the supplementing of potassium enters the picture. Did a doctor recommend that you supplement potassium? The reason why it doesn’t make sense to me is because potassium and sodium are working opposite each other. So while sodium increased blood volume (not pressure) such that there is more to go into your head, potassium reduces blood volume, increasing your POTS.
I am also questioning your low acid on the carnivore diet. Let me explain how stomach acid works:
The human stomach acid pH is 1-1.5 when we are healthy, and so we don’t need much of it. When we eat acidic foods–such as plant matter–our stomach acid “weakens” so the pH increases to 2.5 or higher. At such high pH, more acid is needed to be able to digest the same amount of food we could have digested at pH 1 or 1.5, so the amount of acid increases in your stomach, but its ability to digest reduces.
The carnivore diet is an alkaline diet–most animal products have pH of 6 or higher–and hence it strengthens stomach acid, meaning it reduces pH to its healthy level. I have helped many people who had stomach acid issues and took PPIs or other antacids and drank vinegar or lemon/lime juice, to stop all that by eating only meat. So you being on the carnivore diet is the most ideal diet for your stomach and your enzymes to make a full recovery. I am very much confused by your need to take digestive enzymes. I suspect you are either not doing something right in what and how you eat or were given misinformation by someone/someplace.
I am also unsure what you mean by EDS protocol. EDS is a genetic condition–like blue eyes versus green. I also have EDS–it appears to be frequent for migraineurs. There is no food protocol that can override your genetics for EDS. For EDS you need to exercise the right way such that you strengthen the muscles so that your movements aren’t dependent on your connective tissues and tendons.
I hope this helps,
Angela
This is very interesting. I have a question: Is SVT (SupraVentricular Tachycardia) treated the same as VT? I was once in the ER for a pulse of 220bpm for over 2 hours. I get these “attacks” periodically but most resolve at home within 15-20 minutes. At the ER I was given adenosine injections twice, but the heart rate went back up to 180 each time. Then diltiazem finally brought the heart rate back to normal and I was discharged with a normal troponin measurement (taken at the beginning). ER doc wanted me to stay overnight but we were traveling and so he allowed me to be released. Diagnosis was SVT (PSVT) with follow-up with cardiologist.
Dear Judi,
I just responded to your same question on my personal blog. Here is what I wrote there:
Best wishes,
Angela