Let's not forget about potassium

Since I’m always touting the benefits of magnesium….. I want to emphasize strongly the importance of potassium.

The current Conference Room topic deals with the ultimate loss of potassium due to urinary wasting of both K and Mg. This is very important information and if you haven’t been to the CR, by all means go there and read this new topic entitled: The Aldosterone Connection - Breakthrough?

Note this recent exchange and also see the originating thread post by Hans…. We all need to pay attention to our potassium stores and daily intake.

Author: Hans Larsen (---.gv.shawcable.net)
Date: 03-07-04 16:31

PC,

I think you are right on with the urinary K and Mg wasting. Right after an episode my urinary excretion of K was 2.4 g/day and that of magnesium 178 mg/day. However, 11 days after the end of an episode (1 day before the next episode) my daily K excretion was 3.7 g and the Mg excretion was 230 mg. Over the same period my blood level of Mg went from 0.94 mmol/L to 0.87 mmol/L while my blood level of K fell from 3.6 mmol/L to 3.5 mmol/L. I guess that it is possible that the intracellular levels were similarly affected.

Hans



Continuing my post…


Salt depletes potassium. Hypokalemia will very definitely allow palpitations to occur and can even be the initiator of outright fibrillation. Adequate cellular magnesium stores are essential for potassium to do its job.


Since many people are eliminating the higher Glycemic index carbs they are likely also reducing potassium intake. Potatoes….high in potassium, but also high on the GI scale. Oranges – moderate GI but how many times do we eat an orange a day; or a banana – higher still on the GI and almost as bad for reactive hypoglycemia as potato. And smaller appetites will not consume the 3 – 5 grams required.

It’s been suggested that one easy source of potassium is the use of low sodium V-8 as an alternative to consuming huge amounts of vegetables for people with smaller appetites. It can be heated for a nice warm drink as well. Organic vegetable juice – low salt, of course, would be even more ideal But, be a label reader for other ingredients….or blend your own combo of fresh veggies or blend and then cook just a bit. However, one glass of V-8 may not be enough potassium.... read on....


Michael Murray, N.D. says: “It is critical to maintain potassium levels within the body. This can best be done by consuming foods rich in potassium and avoiding foods high in sodium. The daily intake of potassium should be at least 3 to 5 grams a day.”

“Most Americans have a potassium-to-sodium (K:Na) ratio of less than 1:2. This 1:2 ratio indicates people ingest twice as much sodium as potassium. Researchers recommend a ratio of 5:1 to maintain health….or 10 times higher than the average intake."


Some of the potassium containing foods:

Asparagus ½ cup 165 mg. potassium
Avocado ½ 680
Carrot, raw 1 225
Corn ½ cup 136
Lima beans, cooked ½ cup - 581
Spinach, cooked ½ cup 292
Tomato, raw 1 med. 444

Apple 1 med 182
Apricots, dried ¼ cup 318
Banana 1 med 440
Cantaloupe ¼ melon 341
Peach 1 med 263
Strawberries ½ cup 122

Unprocessed meat
Chicken 3 oz. 350
Lamb, leg 3 oz 241
Roast beef 3 oz 224
Pork 3 oz 219

Cod 3 oz 345
Flounder 3 oz 498
Haddock 3 oz 297
Salmon 3 oz 378
Tuna, drained 3 oz 225

SIGNS OF POTASSIUM DEFICIENCY & SYMPTOMS
Muscle weakness
Fatigue
Mental confusion
Irritability
Weakness
Heart disturbances,
Nerve conduction problems
Problems with muscle contraction
-often seen in the elderly

Dietary deficiency is typically the cause – too much sodium; low potassium. However, dietary deficiency is less common than that among people who regularly exercise and have higher potassium needs.


POTASSIUM LOSS FROM EXERCISE
The amount of potassium lost in sweat is quite significant, especially with prolonged exercise in a warm environment. Athletes or people who regularly exercise have higher potassium needs. Because up to 3 grams of potassium can be lost in one day by sweating, a daily intake of at least 4 grams of potassium is recommended for these individuals.

REPLACING POTASSIUM
Over 95% of the body’s potassium is in the cells. A potassium shortage results in lower levels of stored glycogen. Because exercising muscles uses up glycogen for energy, a potassium deficiency produces great fatigue and muscle weakness, the first signs of potassium deficiency.

Potassium supplements are available in forms of either potassium salts (chloride and bicarbonate) potassium bound to various mineral chelates (aspartate -a no-no for afibbers-, citrate, etc.) and food-based potassium sources.

Supplements are restricted to only 99 mg. per dose because of problems associated with high-dosage potassium salts; however, popular so-called salt substitutes such as NoSalt and Nu-Salt are potassium chloride and provide 530 mg of potassium in 1/6 of a teaspoon. Potassium supplements are also available by prescription in flavored formulas but can produce nausea, vomiting, diarrhea and ulcers when given at high-doses.

Dr. Murray recommends only food sources or food-based supplements.

The estimated safe and adequate daily dietary intake of potassium set by the Committee on Recommended Daily Allowances is 1.9 grams to 5.6 grams. If diet does not meet body potassium requirements, supplementation is essential to good health. This statement is particularly true for the elderly, athletes, and people with high blood pressure.

SAFETY ISSUES
Most people can handle excess of potassium. The exception is people with kidney disease and they may experience heart disturbances and other consequences of potassium toxicity. Individuals with kidney disorders usually need to restrict potassium intake and follow the dietary recommendations of their physician. Supplements are contraindicated when using a number of prescription medications, including digitalis, potassium-sparing diuretics and the angiotensin-converting enzyme inhibitor class of blood pressure lowering drugs.


RESOURCE:

Encyclopedia of Nutritional Supplements
Michael T. Murray, ND.



PPP = PREVENT PALPITATIONS with POTASSIUM

Jackie

Jackie - excellent post as usual. About the low sodium v8 juice, 1 glass is definitely not enough, but 2 [8oz.] glasses a day provides 1800 mg K, which, with plenty of vegetables, approaches the right amount.
PeggyM

Jackie,

Thanks for the informative Potassium post. I had forgotten about sodium depleting it and had a rude reminder the other day. Our breakfast sausages were unusually salty, but I ate some anyway: a few hours later I was in a-fib. I quickly took 300mg. Propafenone, vitamins, 2 packs of EmergenC and a big glass of V8 about 1 hour later. I converted in under 3 hours (really short for me) - it may well have been the juice that helped. I eat few salty things, but I do perspire a lot (always have), so I probably need lots of Potassium.

How are you doing?

Cheers, RK

Hi RK - I'm doing well. I'm in the process of getting back on Coumadin and going off Flecanide again.... just to see if this recent glitch was isolated or if I need a touch up....so stay tuned....and wish me luck on the former, not the latter.

Regarding too salty foods....that has been my experience exactly...although I didn't get outright afib, I would get that unsettled feeling and some PAC's....if I rushed to get in some potassium, it would reverse.

I think having some supplemental potassium to carry in one's pocket for emergencies when eating out would be a helpful thing to do. I carry it and take it immediately when eating out and I sense that the food is overly salty. Doesn't take much because although I like salt, I don't use much and sometimes food, even at the better restaurants, has salt added...why I don't know.

Those little packets of EmergenC are great for this purpose - refreshing -and I believe the selection includes one high in potassium...as I recall. I use them a lot in the summer on the golf course.

PC has indicated that Dr. Lam says we can take up to 15 grams...Dr. Murray says we require around 5 or so. More if we exercise and sweat.

The case for potassium is too important to be forgotten...that's why after the CR topic, I was prompted to post.

This is over-simplification of the CR topic, but the bottom line remains we need magnesium for efficient and proper cellular functioning and then enough potassium to keep us out of trouble...if one or both of these minerals (electrolytes) is in short supply, those of us prone to afib are going to get into trouble either with symptoms (PAC's or outright afib.)

Jackie

Thanks, J!

Thanks, Jackie, for a very informative post.

When I have been admitted to the ER for afib, blood tests showed that my potassium levels were on the low side. Potassium administered through an IV stopped them within a half hour.

I haven't had the same luck stopping attacks by popping potassium capsules, however. I wonder why?

I'm now going to pay more attention to K.

Carol

Jackie,

Thank you for this reminder and a good post. I particularly liked your idea of the EmergenC w/added K. I'll have to try that.

I'm probably not getting enough K in my diet, as I do salt my meats with Johnny's, but have not had problems with this. On the other hand, RK, when I eat sausage, I'll go out of rhythm within a very short time. Sausage usually contains MSG, so you might check that. Now for my question on this. Is it strictly the glutamate, or is it the glutamate in combination with the Na? Does glutamate have some way of carrying the Na directly into the cell, and does this cause K depletion? I have to believe it's more to do with the glutamate. My reasoning, is I was doing whey protein shakes and had to stop, due to causing me arrhythmias. The drink powder itself was high in K, and the fruit I added was also K rich, but the powder was also high in glutamate.

Hope all goes well, Jackie, and you never experience AF again.

Richard

Richard - thanks for your kind comments.

I was doing a whey-based protein powder for a while and noticed increased palps and then, of course, about that time, Fran was banging her drum about glutamate...so I eliminated the whey protein.

I think, from my experiences, there are two separate reactions - one to the glutamate and the other from just too much sodium in foods...now if they should occur together...that's a double whammy.

I've had restaurant sausage which is terribly salty and I've had home-made sausage with no added chemicals or salt. The latter never produced palps or afib. Probably salt helps as a preservative in some commercially produced sausage...or anyother meat that tends to spoil quickly.

Just a guess.

Jackie, great info. Here's another piece or two of my personal afib puzzle. I am too old to be doing this, but I play basketball really seriously. Every Friday, we do that for more than an hour--in South Florida, where even in an air conditioned gym, I sweat like a pig. On weekends, I frequently spend a few hours working or messing around in my yard or garden in 90+ degree temps with 90+ % humidity. For the longest time, my afib came on Fridays! I started making sure I consumed a lot of sports drink to replace potassium, and that has helped.

Another piece is that I cannot tolerate salt in food. My wife doesn't use any salt in cooking and when I eat prepared foods or someone else's cooking, I can immediately tell it has a high sodium content because I get thirsty. Other than Fridays, frequent episodes of afib occured after eating out or going to a party or something where I ate foods that apparently had salt in them.

If I have some sort of salt intolerance and get my potassium depleted on a frequent basis, that could well be the source of my afib issues. What do you think?

John

John,

I'm not a endocrinologist, but it's my understanding that the term salt intolerant is used to describe those individuals that retain more of their dietary Na than does the general population, all else being equal. This is thought to be mediated by aldosterone and manifests as hypertension.

Their intake is not greater, just their retention of it. It's not the salt that causes the loss of K, but the aldosterone. Blood aldosterone is presumably set at a higher level in the salt sensitive. So, unless their intake of salt drops, they should not lose anymore K than for the normal individual. It seems to me that, if dietary intake of Na, i.e., salt, is increased in someone that is salt sensitive, then aldosterone should temporarily drop and more Na should be secreted/excreted and K retained.

The problem is keeping Na intake low enough to avoid hypertension, yet high enough to avoid depleting their K.

That is not to say that a salty meal can't trigger an episode. It's just that many hormonal regulatory mechanisms are intricate and complicated and outside my area of expertise.

PC

To salt, or not to salt. That is the question.. Whether it be nobler ...... ok enough shakespeare.

But seriosly, If I am to understand PC correctly than too much Sodium is bad if you are suffering from Sodium retention. But if your not Na retentive then Ingestion of amounts of Na, but not enough to cause hypertension, is ok because it eill help you to retain Potassium???


Ok, well I thought of this before but I've been toying with the idea of mixing my nosalt (potassium chloride) with my Celtic Sea Salt. Cuts down on sodium and helps raise potassium. Is it a good idea??

Adrian

Adrian,

You read me correctly.

This is a controversial area. Mainstream medicine has recently lowered its recommendations for salt intake and has noted that most Americans far exceed this target. But there's more to it than that. For a good discussion of this please visit

[mercola.com]

PC

I noticed in Jackie's first post that Potassium supplements are contraindicated for people using ACE inhibitors for hypertension. I think the ACE inhibitors tend to retain K but are the levels 'retained' serum or intercellular and which one would have the most impact on Afib? I was using potassium supplements for a long time until my doctor found a slight increase in serum levels over norm and advised me to discontinue them. I believe my Afib has been worse since then so recently I have started to cut back on sodium and increase the potassium in my diet. I guess it wouldn't hurt to try this for a while and see what the next blood test shows. Does anyone know what the risks might be in having an elevated serum K level?

Ron

Ron, I'm not sure what the risks of elevated serum potassium levels are but I do know that only about 2% of potassium in the body is in the blood serum. The rest is in your cells, so if you are really interested in what is happening then the best indicator would be an intracellular test www.exatest.com .

Adrian

Ron -

A year ago I had both a serum and intracellular test done and my serum potassium was slightly high, but the intracellular level was within the normal range ( slightly towards the high end). My doctor had also told me to cut back on the potassium when he saw the serum level. I assume the intracellular test is more accurate but I'm not sure.

Lorraine

Richard

MSG or free glutamate is the single salt of glutamic acid ie mono SODIUM glutamate.

When the glutamate arrives at the NMDA receptor it displaces magnesium and potassium and allows calcium and sodium to flood into the cell - hence the excitory stimulation and nerve cells firing themselves to death. At present I am trying to find the correlation between MSG and aldesterone levels. I know it is there.

[www.chemsoc.org]

"One of the first glutamate receptors to be recognised was the N-methyl-D-aspartic acid (NMDA) receptor. Activation of the receptor by NMDA or glutamate, agonists for this receptor, opens the ion channel. This action involves releasing magnesium ions from their usual 'plugging' action and allowing sodium and calcium ions to enter the cell and potassium ions to leave it. The decrease in potential difference between the inside and the outside of the cell, coupled with other receptor changes in the cell, is responsible for information transfer."


To be honest I don't think avoiding salt is the answer. Avoiding table salt is good as there is little but sodium and alluminium in it and I suspect that it is this table salt which causes the problems along with mono sodium glutamate - both added to all processed food. Sea salt is another matter and contains trace elements of all the minerals needed - including Mg and K. So the body can easily metabolise it, unlike table salt which will deplete the body of minerals as it calls on Mg and K (along with many other minerals) to metabolise the table salt devoid of all goodness.

Fran

John - you have the official answer from our resident MD....

My opinion is that I've experienced what you have.... other people's cooking and restaurant food is over-salted. It definitely bothers me when I eat it unless I also take potassium with the meal.

I am not salt-sensitive. I do not retain fluids when I consume salt.

I do use salt on food at home - I don't cook with it, but if something needs the taste of salt, I add it but I use either sel de mer sea salt from France or Real Salt mined from ancient salt beds in Utah (I think)....

The reason I use this is there is a small need in the body for sodium. This is recognized in medical circles. However, commercially produced salt has added chemicals and may be problematic for some people.

From the sheer economics of using good salt versus commercial salt, we can know for certain that prepared foods and restaurant food will not contain sea salt....unless the food is organic and the label specifically states the use of sea salt.

For me, the problem comes in with the use of commercial salt... I can salt foods at home, appropriately, not a huge amount ...actually, it doesn't take much and I never experience afib.

That said.... I would tend to think your potassium stores are marginal and when you exercise to "sweating" intensity, you will lose K along with other essential electrolytes. No question in my mind that if one loses enough, afib can enter the scene.

My son lived in Florida for 14 years some time back and I have been there with the humidity at 90% and watched him absolutely gush perspiration while toiling over a task. Hydrate and replenish electrolytes. Absolutely essential. If I can find it, I'm reposting a comment published by a doctor who talked about athletes and losing electrolytes.

Now the aldosterone factor is huge here and for afibbers who can't seem make any progress toward diminishing or outright eliminating afib, should follow the CR post carefully and plan to take steps with an endocrinologist for assessment.

Last... I take exception to one comment you made in your post, John....that you're too old to be playing serious basketball. You are never, ever too old to something that you truly love. Follow your bliss - always... that's what keeps you young and healthy. Good for you.

Be well. Jackie