Potassium deficiency

Magnesium measured from a blood test is not very representative of magnesium in heart cells, and can be quite misleading. Does the same argument hold for potassium?

From what I have read, no, it's a simple blood test and/or urine test and the results are fairly definitive.

I agree with gloaming. Several things to note, Serum potassium can vary over the day quite a bit. Also, consuming a bolus or large amount of a potassium supplement will signal the kidneys to quickly excrete it. In my case, I put 2 tsp of food grade potassium citrate powder in a liter of water and consume over the day, my DIY version of "timed release." Anybody supplementing with electrolytes should have normal kidney function.

Many years ago, we had a "Conference Room" for extended discussion of topics. Several were on potassium: [www.afibbers.org] This was on potassium's diurnal rhythm: [www.afibbers.org] This was on using an agricultural potassium meter to measure potassium in saliva.[www.afibbers.org] There was another patient group that had worked out the relationship between serum and saliva potassium. As I recall, both our moderators, Carey and Shannon had these devices and Carey has previously posted about his experience. I'm not sure the meter model now works well for this purpose. Here are a few posts Carey did on the meter topic [www.afibbers.org]

Thanks Gloaming and thanks George for gathering all the relevent posts on the subject.

Some of the links on the saliva testing are broken. Here is a conversion chart for saliva to serum potassium, courtesy of archive.org: [web.archive.org]

Hi

I agree with the position that potassium ( K ) blood tests are very accurate.Some AF is assiociated with heart failure and consequently placed on diuretics which enhance urinary excretion of Mg and K. Under those circumstances a K supplement and or eating foods fortified with Mg and K is advised. Personally one of the few times I experienced a flare of AF was when I needed an extra dose of K supplement that reversed me back to SR. One interesting medical pearls l learned is if someone.has a low blood K which cannot be corrected to normal there can be an underlying Mg deficiency which if corrected will bring the K up to normal.. This is rare but accurately reported in the medical literature.
Hugging

Quote
GeorgeN
Some of the links on the saliva testing are broken. Here is a conversion chart for saliva to serum potassium, courtesy of archive.org: [web.archive.org]

I can testify that measuring K via saliva and using that chart works. The formula used to compute it is available in the original paper describing the saliva/serum correspondence.

After reading all the papers in the library here on the subject, along with many others, I discovered that a fairly substantial bolus of K was the one and only thing (other than cardioversion) that would terminate my atrial flutter (AFL). My rates ran from 230 to 250 bpm, and episodes were happening weekly or even more, so I was obviously pretty motivated to find something that worked. I was in the local ER getting cardioverted weekly, or even more. They quit asking why I was there after a while. They'd just see me and get the crash cart and propofol.

The trouble is, of course, that supplementing K is a potentially dangerous business. That's why you can't buy a K supplement in the US that contains more than 99 mg of elemental K. Don't be fooled by labels claiming much higher dosages. Whatever they're adding to the supplement other than K accounts for the added mgs over 99. It is NOT potassium.

But thanks to the original paper that showed that saliva was a valid proxy for serum potassium levels, I found my solution. So I bought a K meter, and then got my doc to write standing orders for an electrolyte panel whenever I wanted so I could validate it. Then I went and had my blood drawn. As soon as I walked out of the building and got in my car, I did a test on saliva, so they were within 2-3 minutes of each other. When I got the lab results, I compared them and found that they were accurate. I repeated that test 5-6 times over a couple of weeks with the same results. So now I was able to take a large dose of K safely. How did I do that if 99 mg is the legal limit for supplements? Simple, you can legally buy pure KCl powder in bulk form on amazon because it has lots of legitimate uses outside of medicine.

So what I discovered was that a dose of 3 grams of K would terminate my AFL within an hour. No other drug could do that, and I tried them all. I was only able to safely take doses that large because of the meter, that paper, and my newfound understanding of K physiology.

My EP, my PCP, and every nurse I ever encountered told me I was going to kill myself doing what I was doing even after I explained how I was able to monitor my K levels and get results in 30 seconds, not 3 days. There is a deep and abiding fear of K drilled into medical providers that I think borders on irrational. But slowly, my EP came around to believing in what I was doing and got on board. So we replaced the big boluses of KCl with maintaining a serum level of 4.5 or better, which for me took a lot of doing. So he prescribed both a potassium-sparing diuretic, an ACE inhibitor, and 80 mEq of K supplements. Man, every time I filled those prescriptions I got a lecture from the pharmacist because the combination raised all sorts of flags. And yet, it worked, and it was hell of a lot safer than a bolus of 3 grams of K.

So I spent 2 years, from 2015 until my final ablation with Natale in 2017, relying solely on K to keep me out of AFL. I've been asked twice to write articles describing exactly what I did, but I declined them both. Why? Because you really can kill yourself supplementing K if you're not extremely careful. I was afraid someone would take an article I wrote, follow it carelessly, and end up dead. All it would take is for someone with impaired kidney function to try it and that could be fatal. Secondly, I knew if I published an article like that in a public venue like Medscape or WebMD, I would get blasted to hell and back by doctors who were taught that patient supplementation with K is a virtual death sentence. So my advice now is if you want to raise your K levels, diet is the answer. Forget bananas. Go lookup the highest K-containing foods and eat all you want. It's a truism that a high-K diet is also a healthy diet.

Anyway, I'll stop going on about this because I can go forever, and I don't want to go down the rabbit hole of explaining why that is from an evolutionary standpoint.

And, Hugging, before you say anything, I had been supplementing Mg for several years before I began the K program.

Carey
Interesting story. There is a report of a long community study involving large numbers of participants with no prior history of cardiovascular disease including AF and when they terminated the study there was a strong correlation with AF and low K blood levels. Your approach was based on good science. What I think is interesting is you recognized the need to self monitor K in your case. The corollary for me was self monitoring my EKGs. In my opinion it is why I could follow my heart rhythm by titrating dose of my Mg supplement. Had I not done that I would have not recognized conversion to SR at 24 weeks . If I hadn’t self monitored my EKGs I would not have recognized improvement at 24,weeks which I learned was compatible with the underappreciated time needed for conversion . It is based on multiple Mg half-lives of 6 weeks needed to replenish Mg deficiency in hearts of almost all who have AF.

A low serum potassium level (2.8 mEq/L, from memory) at the ER (my one and only one for afib) visit flagged low potassium as a possible actor. Two months later (9/2004), I had an intracellular ExaTest that indicated magnesium was off range low. Even back then, member Jackie (now 89 and doing well as I recently chatted with her) was posting about getting your magnesium optimized prior to working on potassium. Per Huggings comment about tracking, I'm a big fan. In the pre-Kardia days, I built my own cumbersome ECG and using it in parallel with a Polar strap, determined I could differentiate between PVC's and PAC's recording beat to beat heart rate measurements with the Polar strap and watch for later download and analysis. I would sample for 30 minutes while meditating in the mornings to minimize artefact in the data. I used PVC & PAC counts/hour as a metric to titrate my electrolyte dosing to minimize these counts to good effect.

I continue to track many things, related and unrelated to afib. I experiment with many compounds, small molecules and other practices. I never know what may turn up in the tracking. One recent observation with a small molecule I'd been using topically, when I took it orally it appears to have approximately doubled what were previously good overnight heart rate variability values of 45 ms (I'm age 69) to 90 (of course there is daily variability). Unlike in Huggins' case, this did not indicate afib. My average heart rate was 45 BPM and lowest was 39. When I woke up, I did a 2.5 minute HRV test and I could see the increase visually in the heart rate trace & it was definitely NSR.

Reviewing some 2004 posts, in 2004 member PC (AKA Pat Chambers, MD) posted: "... Since an alkaline urine with plenty of HCO3- pulls Mg++ and K+ out of the body with it (to maintain electrical neutrality), alkalosis e.g., hyperventilation, results in lowered levels of body Mg and K. I empirically determined that doing long duration exercise breathing only through my nose mitigated vagal triggers from exercise, possibly due to this reason?? I almost always nasal breathe now 24x7, I tape my mouth at night and even for high intensity intervals or hypoxia (7.5% O2)/ hyperoxia (80% O2) training during HIIT or alpine skiing at elevations from 11-13,000'.



Edited 1 time(s). Last edit at 03/17/2025 08:40PM by GeorgeN.

Quote
Carey
But thanks to the original paper that showed that saliva was a valid proxy for serum potassium levels, I found my solution. So I bought a K meter, and then got my doc to write standing orders for an electrolyte panel whenever I wanted so I could validate it. Then I went and had my blood drawn. As soon as I walked out of the building and got in my car, I did a test on saliva, so they were within 2-3 minutes of each other. When I got the lab results, I compared them and found that they were accurate. I repeated that test 5-6 times over a couple of weeks with the same results. So now I was able to take a large dose of K safely. How did I do that if 99 mg is the legal limit for supplements? Simple, you can legally buy pure KCl powder in bulk form on amazon because it has lots of legitimate uses outside of medicine.

Brilliant approach you used in the past to monitor your K levels Carey. I imagine a day when accurate electrolyte testing will be available and EP's will be routinely requesting a panel of the 4 key heart electrolytes, and work on getting them in balance before bringing out the "big guns". I read in Dr Carolyn Dean's book called "Heart Health ...", that it can take up to a year to get Mg levels in the heart to the required level.

In my case, I started drinking about 2L of Waller water per day in Jan/25 and have noticed that my AFIB incidents do not last as long. From Sept/20 to Jan/25 before the Waller water an AFIB incident would take a day and a half before going to NSR. Since the last 3 months, AFIB has gradually converted to NSR or Unclassified (KardiaMobile terminology) from a day, to six hours, to a couple hours and now to 10 minutes or so. I also started taurine and l-arganine during this period so they could also be contributing.

The K is still a concern. The measurement issue you raised was also in Dr Dean's book, "Since 98 percent of potassium is found inside the cells, measuring potassium in the blood can be misleading."

I like the method GeorgeN uses with dosing K in his hydration water. But I think I need to wait until I see no more improvements from the Waller water before either stopping it or creating a new water with potassium in it.

Quote
TomR
I like the method GeorgeN uses with dosing K in his hydration water. But I think I need to wait until I see no more improvements from the Waller water before either stopping it or creating a new water with potassium in it.

My strong suggestion would be to not stop the Waller water. It is also possible to increase the Mg++ concentration in WW by changing the ratio of the undiluted WW to dilution water ratio and see what that does for you. Though I don't regularly consume WW (because of the hassle of creating it), I have consumed it undiluted.

You may have already seen these posts, the first one has a link to a huge set of posts done by the late Erling Waller on magnesium bicarbonate water (i.e. WW).

In this post by engineer ghg, the tinyurl link goes to a large document he created on magnesium acetate, which is supposed to convert to magnesium bicarb in the body. Also note how he got his RBC magnesium levels up.

I will have a look at those posts.
Am nearly done with Dr Carolyne Dean's book on "Heart Health ..." which, in addition to being a marketing tool for her electrolyte products, has some interesting observations on AFIB from afibbers and other medical practitioners.
Re her magnesium product, she seems to be saying that its ionic form makes for greater bioavailability. I have not researched this claim but it appears on the surface to be what Waller water is all about. His claim is 12 x greater bioavailability -- perhaps I'll also find out how he came to make this claim in the link to his posts. Thank, as usual, George. Always at the "top of your game" ! Cheers