Potassium vs Low Carb Diet - A Balancing Act

I have been wanting to ask a question for a long time.

I have been trying to slowly get off my medicine, Metoprolol. My regular cardiologist is okay with me doing this, even suggesting it since I try to eat healthy. I have tried in the past unsuccessfully because I have experienced some extra heart beats. This time it seems to be working because I am making sure that I take approximately 800 mg of magnesium, and get at least 4700 mg of potassium from the foods I eat (I have been recording my foods using cronometer.com). At this point, I am only taking 12.5 mg of Metoprolol hoping to make it zero shortly.

However, I find it difficult in trying to get 4700 mg potassium without supplementation and still maintaining a low carb diet which I am also trying to do. Some people on this forum follow a keto diet which states one should keep their carbs below 40g. But this seems difficult when needing so much potassium for a calm heart.. Those foods high in potassium are also high in carbs such as winter squash, potatoes (which I don't eat), tomato juice, etc. Beet greens seem to be low in carbs and high in potassium. So, I eat a lot of those as well as swiss chard. If I eat too many carbs, my sugar goes higher than I want it to be. Right now my fasting glucose is in the 80's or low 90's.

I read again Hans Larsen's book, Lone Atrial Fibrillation Towards a Cure and he says we should adhere to a diet containing 30%protein, 30% fat, and 40% carbs. Isn't this too many carbs? I usually average around 15% protein, 67% fat, and 18% carbs. A keto diet would say I am eating too many carbs.

I guess I am trying to find the right percentage for proteins, fat, and carbs and making sure I get enough fat for my brain. There is a lot of information out there that says we need saturate fat for our brain. But, it may depend on the individual since we are all an experiment of one

My question - how does one maintain a low carb diet, keep a proper glucose level, and get at least 4700mg of potassium (without taking potassium supplements since Hans says he wouldn't take them) to make sure the heart stays in normal rhythm? Any thoughts would be most appreciated. Thanks!

Marsh

Marsh,

I generally run my diet keto. Keeping track of my macros, at least in detail, is not my forte'. I once looked at it at <cronometer.com and I was getting 80-90 grams/day carbs, of which >50g/day are fiber. Most of my carbs are from non-starchy veggies (I don't eat grains, legumes, nightshades or seeded veggies. My protein was 60 g, of which a max is 20g/day from shell fish, white fish or eggs (about a 4 oz serving). Most of my calories are from fat, mostly unfiltered olive oil, avocados and tree nuts (macadamia, pistachio, walnut, pecan, hazelnut). Also I don't track my potassium. I used to supplement with 2 or more g/day of potassium (unlike Hans, I have no issue with potassium supplements). I've found that I don't need to as long as I keep my magnesium intake (from supplements) high. Currently I take about 200 mg/day of potassium as supplements, as citrate. This is mostly for the citrate, as I had kidney stones 15+ years ago and the citrate mitigates that risk.

As to how many carbs will be ketogenic. This will vary by individual. Exercise levels, metabolism and fasting will impact this quantity. I fast 22 hours/day.

My last serum K was 4.3 mmol/L. This is right where I want it. So I have no reason to supplement. For me, magnesium is the key.

I should note that a keto diet can pose risks for afibbers, especially during adaptation. The electrolyte shifts that occur with low insulin can cause afib in those who are at risk. A low carb and especially a keto diet is NOT a low sodium diet.

George



Edited 1 time(s). Last edit at 10/03/2016 02:44AM by GeorgeN.

Hi Marsh - Most practitioners of functional and restorative medicine feel that dietary intake emphasis needs to be on more protein and more healthy fat and much less carb intake, so your ratios tend to meet some of the typical recommendations. Metabolic profile testing can determine areas of deficiency or excess, and as George indicates, genetic testing also dictates diet to help prevent genetic expression of gene mutations.

About potassium… as George points out… we know that unless the body is optimized in intracellular magnesium, then adding more potassium typically doesn’t work and won’t help prevent arrhythmia.

When discussing potassium intake, keep in mind that it is the ratio of potassium to sodium that makes the difference between health and imbalance disorders. If sodium intake overpowers potassium, then that prevents potassium from working as it should and among the consequences can be arrhythmia and hypertension and more.

The RDA lists potassium intake as 4700 mg as a guideline. Many people find the use of the Cardymeter for measuring potassium levels helpful so they aren’t likely to go beyond a safe intake level from all sources. That said, however, Paleo man consumed between 10,000 and 11,000 mg of potassium-- obviously from natural sources.

If you consider as an example…that the RDA for magnesium is 420 mg for men and 320 mg for women over age 51 years (source: National Institutes of Health Guidelines) … that serves to emphasize the “guideline numbers” point which, in the case of magnesium. is found to be woefully low when considering the actual uses throughout the body. If it were more realistic, then quite likely the increasing incidence and prevalence of Afib would not be as persistent. Many doctors conversant with magnesium’s function in the body make that observation.

So, when potassium intake is solely from foods and with smaller appetites, it may be necessary to supplement to meet the 4700 mg range, just as it is with magnesium's effective range for afibbers. I know that I’m not alone in finding that I need to supplement with potassium because my appetite has diminished with age and my meal portions are small. I also supplement when I occasionally consume restaurant food as that can have high sodium content. (I use both potassium gluconate powder and potassium citrate) When we talk about potassium intake, the conversation must always consider as well, sodium intake from all sources – many of which are hidden or obscure.

Note that there are various guidelines or ranges, including RDA, RDI, AIs or Adequate Intakes-- all used as goals for approximate intake. Obviously, there will be individual “need” or requirement variations according to age, gender, size, activity…and as we know, interferences that prevent or compete either in absorption/assimilation or utilization--such as an overabundance of Ca blocks Mg function as does sodium blocking potassium.

Caveat: It’s obviously wise to understand the cautions for both magnesium and potassium supplementation which indicate that when used, it’s crucial to know for certain that one has healthy kidney function because excess potassium in individuals with chronic renal insufficiency (kidney disease) or diabetes can result in hyperkalemia or sudden death. Magnesium can also cause a problem but typically, before it becomes crucial, excess magnesium is eliminated rapidly via the bowel tolerance issue. However, in those with kidney dysfunction, supplementation with either should be medically supervised.


Now, all that said…. back to Paleo man’s consumption of potassium.

Lead author of The Salt Solution, Richard Moore, MD, PhD… says:

Moore: “ Let me give you a very interesting statistic. In 1985, The New England Journal of Medicine published an article titled "Paleolithic Nutrition." The authors, who had credentials as anthropologists specializing in the Paleolithic era, determined that, on average, our caveman forebears got around 11,000 mg of potassium daily and about 700 mg of sodium. This, by the way, is about the same ratio that modern-day hunter / gatherers have. It works out to a dietary K Factor of 15.7.

Today, in the United States, that 11,000 mg has shrunk to 2,500 mg of potassium. Meanwhile, the sodium intake has increased from 700 mg to 4,000 mg. This is a K Factor of 0.6. You would not expect that any animal species, human or otherwise, could live for several million years with a huge potassium intake and rather modest amounts of sodium and then suddenly flip-flop this ratio with impunity. The scientific literature supports our conclusions.

There is absolutely no doubt that the imbalance thereby produced influences at least ten serious diseases and very probably several others. This is why we think The Salt Solution is an extremely important book, and we hope that people will read it. It will enable them to correct this huge dietary error. A daily ration of 2,500 mg of potassium is far too little. And, of course, as virtually everyone should know, 4,000 mg of sodium is at least ten times as much sodium as people need. [www.drpasswater.com]

Dr. Moore has a PhD in Ph.D. in biophysics and a 40 year career as a college professor and research scientist. In addition to The Salt Solution, note these other books by Richard D. Moore, MD, PhD.. [www.amazon.com]

Paleolithic diets had about 16 times more potassium than sodium, whereas modern "civilized" diets have about 1.6 times more sodium than potassium. Interview with Herb Boynton ( co-author The Salt Solution) on Potassium: [www.drpasswater.com]

In 2011, Conference Room Session #72 on the topic of Potassium/Sodium Ratio in Atrial Fibrillation was published. It is worth restating the first few paragraphs here for relevant understanding and emphasis:

February 7, 2011 – June 11, 2011
SUBJECT:
Potassium/Sodium Ratio in Atrial Fibrillation

Sodium and potassium Biophysicist Richard D. Moore explains:
"For purely physical reasons (connected with the law of osmotic e
quilibrium), inside the cell the sum of sodium and potassium must
be constant. This means that... sodium and potassium are unalterably
linked together like two children on a teeter totter. You can’t change one
without changing the other.

"Thus, in the perspective of biophysics, it makes no sense to
talk about either sodium or potassium alone - these two
substances always affect each other in a reciprocal relation. Hence their
ratio ... reflects the state of the living cell more completely than either
sodium or potassium alone... It is not only a simplifying concept, but a much more scientifically
valid measure of the state of health of the living cell.

"Reflecting the action in the cell, potassium and sodium always work in a
reciprocal manner in the whole body... This means that increased consumption
of potassium will drive sodium out of the body through the kidneys. Thus,
potassium has been called "nature’s diuretic"... This is an example of the fact
that elevation of sodium inside our body cells must always be accompanied by
a decrease in the potassium level." [1, 11]

From the article Paleolithic Nutrition Revisited: A twelve-year
retrospective on its nature and implications: [2]
"The nutritional needs of today's humans arose through a
multimillion year evolutionary process during nearly all of
which genetic change reflected the life circumstances of
our ancestral species. But, since the appearance of
agriculture 10,000 years ago and especially since the
Industrial Revolution, genetic adaptation has been unable to
keep pace with cultural progress. Natural selection has
produced only minor alterations during the past 10,000 years,
so we remain nearly identical to our late Paleolithic ancestors and,
accordingly, their nutritional pattern has continuing relevance.
The pre-agricultural diet might be considered a possible paradigm
or standard for contemporary human nutrition."

Sodium (Na) and potassium (K) are critical nutrients, but today’s typical diet
might supply 5 times the amount of Na, and only 1/4th the amount of K
that we evolved with. In our evolutionary past the kidneys became configured to
optimize the body's cellular Na and K levels by conserving the sodium available
and by discarding excessive potassium. Our kidneys have essentially not changed
since then, but the typical diet is now upside down, with disease-causing consequences
for all cells and systems.

Continue: [www.afibbers.org]

Book review of The Salt Solution: [www.afibbers.org]
Also: [www.amazon.com]

NIH reference for Mg RDA [ods.od.nih.gov]


Jackie

Hello Marsh,

I'm in a reasonably similar situation, though in chronic Afib. I can't offer much, I'm afraid, just some comments.
Been using cronometer since mid August, slowly pushing down towards 10% carbs, averaging 12% for the last 7 days, still averaging 17% since I began.
I just assumed Hans Larsen's book was prior to the low-carb (10%) diet for diabetes. (Bernstein, Rosedale, Mendosa, etc.). I also think those of us using cronometer or similar sites are using a procedure that those suggesting what % of this or that aren't actually taking into account. My MD just threw the numbers at me, "10% carbs" and nothing more. She actually suggested chickpeas were fine. Everyone else seems to go by lists of what you can or cannot eat, etc.
Very few vegetables seem to have no carbs. I found one ... fresh basil!
A lot of vegetables recommended in these diets have carbs that cronometer *might not* reflect the effect of the fiber on the carbs. E.g.: artichokes, sunflower seed spread, eggplant, chard, others. I have had to adopt them as "condiments", rather than food. (This, in my view, but I would have to actually verify this with a glucometer, but I'm not up to that yet.) I have found I just can't find a way to fill up on vegetables which doesn't up my carb % on cronometer. I'm just under 50 net carbs.
As GeorgeN says at the end of his post:
"A low carb and especially a keto diet is NOT a low sodium diet."
I have found it *very* difficult to push the potassium up and also avoid the high sodium that seems to come with the same vegetables. Same problem with 2 or 3 different types of fresh fish available to me.
I agree with you about potassium supplements. I'm not sure if my kidney/liver numbers are safe enough. So I only manage to reach a 50 to 70% mark for potassium and a potassium / sodium ratio from, say, 3 to 1, to, over the last 7 days, 3.4 to 1.
I'm amazed you manage "4700 mg potassium without supplementation".
Chard seems to be always in season, but it rates high for me in sodium. Beet greens are not readily available, as beets are usually sold without the greens. Beet greens per se are only sold by "organic" producers.
I'm wondering how you manage.
All the best,
ginny

Jackie,

Thank you so much for your response. I appreciate you pointing out that I need to consider the potassium to sodium ratio. So, what should be an appropriate ratio of potassium to sodium? Should this ratio be 4 to 1 if I am understanding the article correctly? I had to reread it several times and I still feel that I need to reread it some more. I am probably not understanding it completely. Today, my potassium to sodium ratio was 2.4:1 - it probably needs to be better.


Ginny,

I do supplement with potassium gluconate if I don't get 4700 mg of potassium from food. I buy organic beet greens, but I try to grow beets and eat the tops if the bugs don't get to them first. I also grow my own swiss chard as well as other greens until it dies from the cold weather. I am glad I found cronometer.com because I didn't realize how low my potassium intake was from food. Now, I will check the sodium intake as well.

Marsh - yes... read the post at this link that was referenced at the end of my response.
[www.afibbers.org]

Thanks, Jackie!!

Have you done an Internet Search on Foods high in K+? When I analyzed my diet, I was getting over 8,000mg/day because I was eating Foods that were high in K+ like Spinach, Steak and Chocolate. My case in somewhat unique as I was overhydrating, but when I cut down on K+ and added more Salt, and this resolved my extra beats (PAC's).

These recommended Numbers of this and that are just for an average person, and is a guideline to follow, but may not apply to everyone. With controlling PAC's experimentation may be needed. An individuals hydration status affects this sort of thing. The more fluid a person consumes, the more Na+ will get flushed out of the system, also environmental conditions can effect this if you perspire alot in the heat.