Electrolytes

Since so many of you are way ahead of me on all the research and thinking about this problem...
Does anyone have any idea how off one's electrolytes need to be to wack out your heart rhythm?
Do you have to be clinically low on potassium to have a problem, or can low end normal be problematic?

I started taking chlorthalidone fo BP late February-ish, and my potassium has dropped to low end of normal since then, which makes me wonder if that could have precipitated my arrhythmia issues.

7/30/14 1/27/17 1/19/18 5/31/18 7/17/18
Potassium, S/P 3.3 - 5.0 mmol/L 3.7 4.0 4.5 3.5 3.4
Sodium136 - 144 mmol/L 138 139 138 140 139


My first thought on this was eat more banannas, my second was to ditch the chlorthalidone for a bit and see what happens. They put me on Diltiazem at the ER 5/31.... I've read that that is also supposed to help BP... so I'm thinking it might be worth trying that alone for a while. My glucose ia also up since starting the chlorthalidone... which gives me a second reason to consider discontinuing it.
I'm contemplating running this idead by my docs (also contemplating just doing it) but I thought I'd ask here since I am under the impression that there is a big cohort of 'tried everything' people here so I thought I'd ask.

Thanks again for you input! I imagine I grasping at straws.. but hey... I suspect I'm not the first to do that.

Yes, your potassium is #1 on AF's Most Wanted List. I know you said in your previous thread that you have kidney issues. Get the function tested and then discuss supplementation with your doctor. It clearly needs to be done. Don't take no for an answer, unless the kindeys preclude it.

Bananas, while good, aren't something you want to eat a whole bunch of. They have a very sedative effect on the gut muscles. You may find yourself constipated if you overdo it.

Chlorthalidone is a diuretic, so it's no surprise your potassium is low. Your doctor should have anticipated this. Although the potassium levels you posted are all in the "normal" range, for people with afib the normal range doesn't apply. Four of the five numbers you gave would have been guaranteed afib episodes for me. I would recommend that anyone with afib keep their potassium above 4.0 at a minimum, and preferably 4.5. There's a very good article on potassium and arrhythmias in the afib database you should read (link is at the top of this page).

Bananas are an okay source of potassium but there are betters ones. Try some of these instead:

Potatoes, especially sweet potatoes, and especially with the skins left on
Nuts and legumes
Beans
Fish, especially salmon
Squash
Most green vegetables
Most tropical fruits, kiwi fruit in particular
Avocados

One caveat on potatoes is the light pollution that occurs because they sit in grocery store produce departments that are illuminated 24 hours of the day. You'll see that as a greening that occurs underneath the skin when you peel it and it may even be directly visible through the skin if it's really bad. It is a good indication of glycoalkaloid toxicity. Root vegetables are meant to be kept in a cool, dark and dry cellar with a little bit of dirt still on them. Of course, this never happens nowadays. People would think it disgusting.

I'd go with soybeans as an excellent natural source of potassium. Unsalted or lightly salted edamame would be excellent.

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wolfpack
Yes, your potassium is #1 on AF's Most Wanted List. I know you said in your previous thread that you have kidney issues. Get the function tested and then discuss supplementation with your doctor. It clearly needs to be done. Don't take no for an answer, unless the kindeys preclude it.

Bananas, while good, aren't something you want to eat a whole bunch of. They have a very sedative effect on the gut muscles. You may find yourself constipated if you overdo it.

No, I was not the one with kidney issues... thankfully! Other that being overweight and battling my BP I have no issues..

If you have thyroid problems, do not eat soybeans, they interfere with the uptake of the thyroid hormone.

Liz

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bolimasa
No, I was not the one with kidney issues... thankfully! Other that being overweight and battling my BP I have no issues..

Oh, sorry. Then certainly go ahead with some potassium loading either by diet or supplementation.

I'm the one with short-term memory issues.

Anyone seen my keys?

Check some of these reports on the function of potassium. Above all, be sure to have the kidney evaluation from your doctor. Be very cautious if there is any impairment and definitely have them direct your potassium intake. Quite often, it's beneficial to take a measured amount of a potassium supplement so you know exactly the amount you are taking in rather than shot-gun with how much is actually in the prospective food.

Keep in mind, also, that the biochemistry of the benefits of potassium are only after you have optimal magnesium inside the cells when looking for stabilization of arrhythmia. Adding potassium when the magnesium is not adequate can made the arrhythmia worse.

On sources of potassium: Be sure that there aren't other issues with the various food source options.... soy, for example, has an abundance of reports on negative effects on the body. (That's why so many reliable supplement ;abe;s indicate that the products are 'soy free' just to be safe.

Jackie

Well, the cardiologists office called to discuss this weeks test, and the gal I spoke to agreed my K+ was on the low side, and suggested I call my GP regarding supplements. She suggest I should for a 4. not the 3.4 I am currently at.
So went ahead and messages my doc and asked about potential discontinuing the chlorthalidone and/or adding a supplement.
Will see what he says.

Even if I end with the ablation as suggested... I'd like to figure out whats going on so I can beat this problem long term. I really don't want to stay on blood thinners.

You could also just ask for a RX for potassium. I've been taking 10 mEq for years now. It's really not that much, and it's not a "heavy duty" prescription medication like a beta-blocker, anticoagulant or anti-arrhythmic. It's literally just potassium chloride (KCl) in a time-release capsule. Nothing else to it.

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Elizabeth
If you have thyroid problems, do not eat soybeans, they interfere with the uptake of the thyroid hormone.

Liz

What do you mean by this?

Someone else mentioned soy being problematic.
I eat a fair amount of bean curd and tofu...
have never seen it to be problem... and it's certainly a mainstay in asian cultures

1 can of Campbell’s Healthy Request Beef with Country Vegetables has 2340 mg of Potassium. My Cardiologist recommends it. It is considered Heart Healthy. Also just 240 calories per can.

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Jackie
Quite often, it's beneficial to take a measured amount of a potassium supplement so you know exactly the amount you are taking in rather than shot-gun with how much is actually in the prospective food.

As someone who spent over two years taking massive amounts of potassium, both in raw potassium chloride form and in time release prescription tablets, I disagree with this rather strongly. I measured my serum potassium levels multiple times per day during that period with a potassium meter so I came to know very well how the body responds to potassium. What I found is that supplements produce a rapid rise in serum potassium levels, but the kidneys respond promptly and eliminate it almost faster than you can keep up. (I'm assuming normal kidney function here, and if there isn't normal kidney function then you shouldn't be anywhere near potassium supplements without medical supervision.)

For most people who don't have a need for massive amounts of potassium, it's much safer and more effective to get it through food. It's very much like eating refined carbs vs. complex carbs. With supplements you get a rapid rise in serum potassium levels followed by a crash that often leaves you lower than you would have been without the supplement. But with food it's more like a complex carb that acts like a slow time-release. The rise in serum potassium is slow and steady and doesn't trigger your kidneys into rapid excretion.

When I went to the ER (first and last time I ever did that) for episode #1, my serum K was 3.2. That put me on the trail of K, however as Carey says, serum K can change quickly. My experience was that once magnesium was taken care of, my potassium seemed to take care of itself. That being said, I have taken potassium citrate for years. Today I put 4 grams of k as citrate (in powder form) in my water bottle and drink it over the day (my version of time release).

Certainly for me, getting magnesium in order (in my case to bowel tolerance) has been a great part of my ticket to afib remission. If I miss taking my mag afib comes with certainty, usually in 36 or so hours. Because of distractions with serious health issues with other family members, I've managed to miss a couple of doses, which led to afib this year. This really ramped up my level of attention to it.

Bolimasa::

I take a thyroid med and have for many years, it was always said to avoid Soy, there is a lot on the net about this, here is one:

Although soy does have some health benefits, it has a big negative when it comes to your thyroid. Two components of soy, both isoflavones, genistein and equol, a metabolite of daidzen, inhibit an enzyme, thyroid peroxidase, used in the thyroid gland to make both T4 and T3. Diets high in soy can produce goiter (thyroid enlargement) and autoimmune thyroiditis such as Hashimoto’s. Being low in iodine, a nutrient essential for proper thyroid function, multiplies soy’s negative effects on the thyroid. Soy can also interfere with you body’s ability to use thyroid replacement hormones.

[www.wilsonsyndrome]

Well, sorry seems like you can't access that page,

[www.medicinenet.com]



Edited 2 time(s). Last edit at 07/20/2018 10:40PM by Elizabeth.

You might consider eating more toward a whole food plant-based diet. The key is lots (lots!) of green (and other veggies). Doing this my blood pressure went from borderline to 106/64 last week, on no meds. It will up your potassium and magnesium and possibly take care of your blood sugar and weight issues too.



Edited 1 time(s). Last edit at 07/20/2018 10:51PM by libby.

I'm no saint when it comes to diet, but it's generally true that if you're eating a high-potassium diet, you're eating a healthy diet. The two are almost synonymous. The opposite is also true. Poor diets tend to be low in potassium.

I would absolutely prefer to up my K+ with real food, not supplements. I'm not a huge believer in supplements for some of the reasons mentioned br Carey above. (Plus I live in Utah, home of plenty of slimey snake oil salesmen, who don't want their industry regulated in an way)
Meanwhile my GP to thought it was reasonable to see what happens if I forgo the bp med for a few weeks..... Probably wishful thinking on my part, but hey, worth a try.

Carey - I agree that food sources are the best for potassium, but many afibbers don't have a Cardy meter and that can be a big problem if they are taking in too much K-containing foods. It's foolish to load up on potassium as the solution.

Remember, the rule for helping to maintain stability and freedom from arrhythmia when it comes to potassium is...
the magnesium inside the heart cells must be optimized first... before adding "tons" of potassium via food or it will make arrhythmia worse. The magnesium experts have always cautioned about this when writing on the topic... and it's been published here in posts for well-over 10 years, at least.

As for the range of potassium that stabilizes .... the kidneys play a role, obviously. I found that if my potassium tested much lower than 4.0... I'd be in arrhythmia. I didn't have a Cardy meter, but noted the lab values for the many times I was tested prior to ECV. Everyone needs to know if they have healthy kidney function.

"Poor diets tend to be low in potassium."..... true.. and that's because of the consumption of packaged, processed foods that are typically laden with sodium/salt which blocks the function of potassium. Plus, some foods contain more potassium than others so it's not an easy solution to just 'guess' to optimize the K/Na ratios.

Jackie

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Jackie
Carey - I agree that food sources are the best for potassium, but many afibbers don't have a Cardy meter and that can be a big problem if they are taking in too much K-containing foods. It's foolish to load up on potassium as the solution.

Unless you have poor kidney function it's virtually impossible to raise your potassium to dangerous levels through diet. It just can't be done because your kidneys will remove excess potassium faster than you can absorb it from food. Magnesium deficiencies are another issue, but lack of magnesium isn't going to make a high-potassium diet dangerous. There just isn't a scenario where potassium supplements are safer or more effective than dietary sources. You can take more of a supplement than your kidneys can remove quickly, but honestly it takes a massive amount to actually put yourself in danger. I've reached a potassium level of 7.0 more than once without harm.

A little fun fact people often don't realize is that we evolved in a potassium-rich, sodium-poor environment. Think about it: primitive man ate a hunter-gatherer diet, which means mostly fruits, vegetables, root vegetables, nuts, berries and some occasional meat or fish -- all high-potassium foods. That's why our kidneys are so efficient at removing excess potassium, and I saw that clearly with my meter. No matter how much potassium I took, my levels would fall back to normal very quickly. But primitive man got very little salt. It was, in fact, so scarce that in later times it came to be used as currency by the Romans and others. And that's why our kidneys aren't so good at removing excess sodium, and why our sodium-rich diets cause problems such as hypertension and water retention. Our kidneys evolved never having to deal with an abundance of salt.



Edited 1 time(s). Last edit at 07/21/2018 06:14PM by Carey.

Carey - I'm recalling one of the afibber's who talked about and still uses the Cardy meter to be sure his potassium levels don't get too high because he would experience AF: Tom C who wrote about the Cardy meter in CR 74. He has had two ablations and still finds that he needs the meter to eliminate the runs of PACs when he gets too much food potassium.
He's very medically oriented so I'm quite sure he would have mentioned he has kidney dysfuction which caused the problem.

Good point thought about the evolution of kidney function.

Jackie

I don't know what "CR 74" means so haven't read his posts, but if normal dietary intake was causing him to become hyperkalemic then either he did indeed have some degree of kidney dysfunction or he was consuming outrageous quantities of potassium, far more than you can ingest even in the highest potassium diet imaginable.

And if you understand how potassium affects cardiac cells, it makes no sense for high potassium levels to cause PACs. That's the opposite of its mechanism of action.

Agree.

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Carey
I don't know what "CR 74" means so haven't read his posts, but if normal dietary intake was causing him to become hyperkalemic then either he did indeed have some degree of kidney dysfunction or he was consuming outrageous quantities of potassium, far more than you can ingest even in the highest potassium diet imaginable.

And if you understand how potassium affects cardiac cells, it makes no sense for high potassium levels to cause PACs. That's the opposite of its mechanism of action.

CR = Conference Room <[www.afibbers.org]
CR74 <[www.afibbers.org]

Carey:
And if you understand how potassium affects cardiac cells, it makes no sense for high potassium levels to cause PACs. That's the opposite of its mechanism of action.

Carey - Long ago in the literature on magnesium for arrhythmia, there was a study and commentary that mentioned about the function of both magnesium and potassium's effect on cardiac cells... and the summation is... that:

'cardiac cells must have optimal intracellular magnesium stores and that's what helps maintain the 'calmness' or reduction in electrical excitability. Potassium works by increasing the refractory period time... (or the time between beats)..... Adding potassium before the magnesium is fully optimized can make arrhythmia or ectopy worse.'

For that reason, back then, we were suggesting afibbers have the ExaTest by Intracellular Diagnostics so see not only the intracellular levels of each electrolyte but also the ratio of those for the functionality aspect. Because it can be difficult for magnesium to access the cell's interior, it's not at all uncommon for afibbers to be deficient in magnesium. The stats say about 80% are found to be deficient. Also, critical is the sodium/potassium ratio that must be balanced as well.

There is significant and reliable info in Conference Room Session 72 on the Ratio of Sodium and Potassium in Atrial Fibrillation based on the science provided by Biophysicist, Richard D Moore, MD, PhD... that also helps explain more on this topic.

Here's a start:

Your Premier Information Resource for Lone Atrial Fibrillation
Publisher: Hans R. Larsen MSc ChE
[www.afibbers.org]
VIRTUAL LAF CONFERENCE
Proceedings of 72nd Session
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 equilibrium), 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 critic al 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.

Our bodies are 'The Body Electric'.[3] Each of the body's cells is like a battery (10, 20 trillion?), charged to their
functional voltage by the enzyme Na/K-ATPase, commonly called 'Na/K pump', or 'sodium pump'. "Depending on cell
type, there are between 800,000 and 30 million [Na/K] pumps on the surface of cells. They may be distributed fairly
evenly, or clustered in certain membrane domains, as in the basolateral membranes of polarized epithelial cells in the
kidney and intestine".[4]

Na/K pumps span the cell membrane, and generate the electrical voltage (potential) to charge the cell/battery by
continuously pumping ~3 Na+ ions out of the cell in exchange for ~2 K+ ions pumped in.[5, 6] In cardiac muscle a
'trans-membrane potential' of about 90 millivolts (mV) is generated (negative inside), which provides for the cell's
electrical requirements: voltage-gated ion channels, calcium pumps, etc. To attain this functional voltage requires the
intracellular K/Na ratio to be at least 20 to 1 [7], which in turn requires the dietary K/Na ratio to be at least 4 to 1.[1] The
kidneys ideally maintain serum K and Na at the levels they were evolved to maintain, but the high intracellular K/Na
ratio can not be attained if intracellular Na is too high (as Dr. Moore explains, above).

Continue: [www.afibbers.org]

Jackie

You keep going back to magnesium but I've already acknowledged it's essential. As the quote you cited mentioned, the effect of rising potassium levels is a widening refractory period, and a widening refractory period reduces ectopy and reentrancy. Taken to extremes, the end result of severe hyperkalemia is paralysis of cardiac cells, a QRS that smooths out into a sine wave pattern due to decreasing contractility, and eventual asystole. That effect happens regardless of magnesium levels.

Thanks, George, for your confirmation of "the potassium factor" as a stabilizing influence.

Carey - yes.. .that's why loading up on potassium isn't a great idea unless, or until you are aware of both the IC Mg levels and also the Potassium plus sodium. Over the years, there have been many afibbers who didn't optimize the Mg first but took an abundance of potassium... foods and/or supplements... and then complained that potassium made the AF worse... as predicted. Anyone who plans to consume a lot of potassium and also has ectopy or AF should have the intracellular levels of magnesium tested so they can avoid that complication....

Jackie

[www.livestrong.com]



Cardiovascular Effects

Magnesium toxicity might adversely affect the cardiovascular system. Severe drops in blood pressure, also known as hypotension, have been reported after taking excessive doses of magnesium. Too much magnesium in the blood can also slow heartbeat or cause erratic heart rhythms, also known as arrhythmias. If very high levels of magnesium accumulate in the blood the heart might stop beating completely, called cardiac arrest.


Additional Symptoms

Severe magnesium toxicity can also cause muscle weakness and difficulty breathing. Changes in mental status might also occur, including confusion and lethargy. Elevated magnesium levels can throw off the balance of other minerals in the body, especially calcium, which can cause additional symptoms. In extreme cases, magnesium toxicity can result in coma or death.


You can get too much of these electrolytes, I took a potassium supplement and it gave me runs of AF, I quit and heart was quiet. I do take a mag. supplement, 1 teaspoon of Magnesium Bisglycinate pwd. in a glass of water or juice, there is 250 mg in that 1 teaspoon. That appears to be enough for me as I do not have any pacs. My potassium level is around 4.5 magnesium is at the lower end of the lab scale, but I feel good and do not have any pacs, so go by how you feel not what some guy writing a book tells you.

Liz

Y'all can think what you want. I think this thread has become futile.

Liz - The info about calcium from Livestrong is not correct according to current findings about the excitatory role that calcium plays in cells. Your cells need only the small, requisite amounts of calcium for balance with magnesium and taking magnesium does not cause a calcium problem. If you doubt that, then read what cardiologist Thomas Levy, MD, says about "Death by Calcium." Yes, we need some calcium, but not nearly as much requirement as there is for magnesium and supplementing with calcium is not good to do for many reasons, esp. for afibbers.

That said, if you take too much magnesium, it typically self-corrects because of the purge from bowel intolerance.

The major caveat for both magnesium and potassium excess is the presence of kidney dysfunction. Everyone supplementing or eating a high potassium-content diet, should verify they have healthy kidney function.

Jackie

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Carey
Y'all can think what you want. I think this thread has become futile.

What exactly is the purpose of this site, it appears that it has become about ablations, two, three maybe, or how about the left atrial appendage, then you can go on lifetime anti coagulants, oh, then you can get a watchman device, sounds like a lot of operations. I think there are people here that would like to read about things that people have done which has helped their AF without an ablation. I understand if AF has become intolerable for some and they can read about successful ablations on here, but not all of us are in that camp. Oh, by the way where is Shannon?

liz

I wasn't suggesting whatever it is you seem to think I was suggesting. I've used potassium and other electrolytes extensively myself and I know all about intolerable. So I don't know what you're going on about with ablations and operations. I simply don't find the current line of discussion useful or productive. Anyone who wants to discuss electrolytes is of course free to do so, but I'm bowing out of this one.

Shannon has been dealing with some medical issues lately. I'm sure he'll be along soon enough.