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Potassium questions

NilaJones

Senior Member
Messages
647
Hello, folks :)

I have been reading through old potassium threads, but am not finding the answers i seek. Will you help me out?

Here's what's on my mind:

1. Are there non-oral routes for taking potassium? Would it have to be IV, or are subQ injections practical?

I have a history of severe gut issues (I almost died, and took 20+ years to heal) and am doing well now so I don't want to push it. I am needing 3 bananas + 500mg in tablets right now, with no B!2, and do not feel I can take more than that safely. So, I don't think I can try methylation unless i can find a safe way to take the massive amounts of potassium that some people need.

2. Do some people not absorb potassium well from bananas? I added them in, thinking I would then be able to reduce the number of pills, but that has not been the case.

3. Is slow-release potassium safer or less safe for the gut than regular? I see conflicting statements on the web. And how about powder vs solid, or citrate vs gluconate vs chloride?

4. After 2 weeks of no B12, I find myself still unable to reduce potassium without muscle cramps. This surprises me. Any theories on what could be going on? I am still taking Folapro.

Thanks a bunch, everyone :). I am working hard to get caught up, here, and appreciate all your new and old posts!
 

Lotus97

Senior Member
Messages
2,041
Location
United States
1. Are there non-oral routes for taking potassium? Would it have to be IV, or are subQ injections practical?
You can dissolve potassium chloride in water and put it in a spray bottle and spray it on your skin to absorb it transdermally. It might irritate your skin so you might want to avoid putting it on sensitive areas.
Is slow-release potassium safer or less safe for the gut than regular? I see conflicting statements on the web. And how about powder vs solid, or citrate vs gluconate vs chloride?
From what I've read, those are more dangerous. The best thing would be to dissolve potassium gluconate into water and drink the water with your food. Potassium chloride is harsher on the GI tract, but people with low stomach acid might absorb it better than gluconate.
After 2 weeks of no B12, I find myself still unable to reduce potassium without muscle cramps. This surprises me. Any theories on what could be going on? I am still taking Folapro.
I agree with Sushi. I would recommend taking only B12 first and then very slowly adding methylfolate (once you're able to tolerate the B12) as methylfolate is much more likely to cause problems compared to B12. Taking methylfolate or any kind of folate without B12 might also cause methyl trapping (but this might be somewhat theoretical).
Also check this thread on side effects from methylfolate:

http://forums.phoenixrising.me/index.php?threads/methylfolate-side-effects.23468/

And have you tried adding magnesium for your muscle cramps? It is another possibility.

Sushi
NilaJones
Low magnesium could also potentially make it harder to raise potassium levels. Or the symptoms could just be from not enough magnesium. Caledonia said she didn't need extra potassium from methylation, but she did say she needed more magnesium.
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
I think slow release potassium is a better choice than immediate release potassium tablets. Mostly because I don't think that the immediate release tablets work very well. I think that the potassium taken is just dumped because the body tries to keep potassium tightly regulated. Slow release forms are necessary to bypass this mechanism and actually give the potassium a chance to get into the cells where it belongs.

I've taken slow release potassium for years with no problems (knock wood of course!).

Ema
 

NilaJones

Senior Member
Messages
647
@ Lotus97 Sushi

Thanks for your help!

I have tried magnesium, 150-500mg, without noticing a difference. Iron helps a little, but doesn't do the whole thing.

I am not having the symptoms on the 'too much folate' list. Rather, I am feeling much better. My inflammation problems have decreased, I am much less brain-fogged, and have significantly more energy (but not a 'speedy' feeling). I am definitely in the 'where have you been all my life' group :).

I used to eat ginormous amounts of leafy greens every day, because that helped me. I have not been eating nearly so much since I started the folate. Not craving them like I was.

I am reluctant to go off the folate because I did so last week for blood tests and it sucked to be so much sicker. I tried just reducing the dose by 1/4, this week, but that too made me sicker (not as bad as none).

I have the same symptoms from B!2 with and without folate. Of course, there is some B!2 and some folate in my diet and my multivitamins.

Yesterday I tried 1/36 of a Perque and that seemed to be ok. I think I have found my 'small enough' dose. Hence these questions about potassium -- I want to have a plan before proceeding with more B!2.

--

So, when taken orally, potassium dissolved in water is better than a tablet? That is counterintuitive, if the goal is to have the Potassium released gradually rather than all at once. Can you clarify?

When using the water spray, what amounts are practical? I'm not familiar with how easily it dissolves -- will I be able to get grams worth onto my skin?

Thank you again, so much :).
 

NilaJones

Senior Member
Messages
647
Ema :

Your post came in while I was typing the above:)

I'm currently taking non-time release, one pill with each meal or snack. Or each banana. I am definitely absorbing some, because my symptoms change with how much I take. Whether i could be absorbing more effectively, I don't know.
 

Lotus97

Senior Member
Messages
2,041
Location
United States
I think slow release potassium is a better choice than immediate release potassium tablets. Mostly because I don't think that the immediate release tablets work very well. I think that the potassium taken is just dumped because the body tries to keep potassium tightly regulated. Slow release forms are necessary to bypass this mechanism and actually give the potassium a chance to get into the cells where it belongs.

I've taken slow release potassium for years with no problems (knock wood of course!).

Ema
My understanding is that if the slow-release tablets don't dissolve quick enough they can damage the digestive tract.
 

Lotus97

Senior Member
Messages
2,041
Location
United States
I am reluctant to go off the folate because I did so last week for blood tests and it sucked to be so much sicker. I tried just reducing the dose by 1/4, this week, but that too made me sicker (not as bad as none).

I have the same symptoms from B!2 with and without folate. Of course, there is some B!2 and some folate in my diet and my multivitamins.
That is strange that you experience the symptoms from B12 with or without folate. If the folate is helping you then I guess you could just do things in reverse which is what you seem to be doing. Hopefully you can tolerate more B12 at some point because that is also necessary. As I said before, folate is more likely to cause problems and there's also the issue of methyl trapping, but you need to find what works for you and it sounds like this is it. Someone else recently reported an acute reaction to only B12 (with no methylfolate). I wonder what's going on:thumbdown:

Yesterday I tried 1/36 of a Perque and that seemed to be ok. I think I have found my 'small enough' dose. Hence these questions about potassium -- I want to have a plan before proceeding with more B!2
Since methylfolate doesn't seem to make a difference in your symptoms there is the possibility that potassium won't help. Even if your symptoms are from overmethylation or overdriving the methylation cycle, there's no guarantee potassium will help your symptoms, but it's worth a try. If the symptoms are from overmethylation then niacin could help as it uses up SAMe/methyl groups, but again I'm not sure if your symptoms are indeed from overmethylation. It's also possible that if you increase B12 gradually you won't run into as many problems.
So, when taken orally, potassium dissolved in water is better than a tablet? That is counterintuitive, if the goal is to have the Potassium released gradually rather than all at once. Can you clarify?

When using the water spray, what amounts are practical? I'm not familiar with how easily it dissolves -- will I be able to get grams worth onto my skin?

Thank you again, so much :).
Why do you need the potassium released gradually? Why can't you just take small amounts throughout the day? Also, some people need several thousand milligrams of potassium so you'd have to take a lot of timed release tablets. And as I said to Ema a moment ago, there's the risk of the timed-release tablets damaging the digestive tract. Rich seemed to think that any type of capsule or tablet carried that risk although Freddd commented that he thought only the timed-release tablets carried that risk.

This is from Rich:
(at the end he mentions the thing about the potassium pills
Why is potassium supplementation needed in methylation treatment?
Potassium deficiency is an important issue to watch for and to correct when a person is doing one of the methylation protocols for ME/CFS.

Freddd is the one who first brought this to our attention, I think because it showed up so strongly with his protocol, which includes relatively high dosages of B12 and folate, compared to what is suggested in the simplified methylation protocol.

It made sense to me from the standpoint of the biochemistry of ME/CFS when he first mentioned it, though I hadn't thought of it before. Here's why:

In 2001, Burnet et al in Australia reported measuring the whole-body potassium content of people with CFS compared to healthy normals. This is possible by using a whole-body gamma ray counter, because all potassium, including that in our bodies, contains a small amount of the natural radioactive isotope, potassium-40, which emits an energetic gamma ray. (This potassium isotope has a very long half-life, and is thought to have been present since the formation of the earth, several billion years ago. It has been decaying ever since, but there is still enough to measure because of its long half-life.) Since the current concentration of potassium-40 in potassium is known, it is possible to calculate the total potassium in the body using this measurement.

Burnet et al. found that the CFS patients who had predominately fatigue but not muscle pain were low in whole-body potassium by more than 10% compared to normal. They also measured the plasma level in the blood serum, and that was found to be normal.

It is known that at least 95% of the potassium in the human body is inside cells. Potassium is the most abundant positive ion inside all cells. So the measurements of Burnet et al. mean that the CFS patients they studied were significantly low in intracellular potassium.

The observation of low intracellular potassium in the presence of normal serum potassium means that there is a problem with the membrane ion pumps that normally pump potassium in (and sodium out) of the cells. These pumps require ATP for their energy supply, and that implies that the mitochondria are not able to supply enough ATP.

We have other evidence now for mitochondrial dysfunction in ME/CFS, so this fits together very well. In the GD-MCB hypothesis, the mito dysfunction is a result of glutathione depletion and a partial methylation cycle block.

O.K., this part was important to explain, because it means that there is no "cushion" in terms of potassium supply in these PWCs.

Now, another thing to note is that it is likely that PWCs have a smaller total number of cells than normal. The reason is that measurements have shown a higher rate of die-off of cells (early apoptosis) in CFS, and also an abnormal arrest in the S phase and the G2/M boundary of the cell cycle (Vojdani et al., 1997). What this means is that the cells are dying off early, and are not being replaced as fast as normal.

According to the GD-MCB hypothesis, the early apoptosis occurs because of damage to the cells by oxidative stress resulting from glutathione depletion.
The arrest of the cell cycle occurs at the stages where the DNA is supposed to be replicated and the cell is supposed to divide, to form two cells. Something is hindering the DNA replication. What is it?

According to the GD-MCB hypothesis, this is caused by the inability of the cells to produce new DNA at a normal rate, which in turn is caused by depletion of the folates in the cells. This in turn is caused by the partial block of the methionine synthase reaction, coupled with the methyl trap mechanism and the catabolism of methylfolate by peroxynitrite, which is elevated because of glutathione depletion.

O.K., so now we have a situation in which the PWC has fewer total cells than normal, and the cells that the PWC does have are lower in potassium than normal.

Now, enter a methylation protocol, which incorporates at least B12 and methylfolate. The effect of this will be to increase the rate of the methionine synthase reaction. One of the effects of this will be to convert methylfolate into tetrahydrofolate more rapidly, and the latter is then converted to other forms of folate, including those needed to make purines and thymidine, which are necessary for making new DNA.

All of a sudden, the cells now have enough DNA to overcome the arrest of the cell cycle, and their rate of cell division goes up, making new cells more rapidly.

These new cells require potassium, and their membrane pumps start pumping it in from the blood plasma. Unfortunately, since the existing cells, which contain 95% of the body's potassium inventory, are already low in potassium, there is no cushion or buffer for the blood plasma potassium level, and if it is not augmented by increased potassium intake from the diet or supplements, the PWC's blood plasma potassium level drops, resulting in hypokalemia. This is hazardous, because it can have detrimental effects on the heartbeat and on other vital processes in the body, such as the use of muscles for breathing.

So that, in my opinion, is why it is important to watch the potassium level when on methylation treatment.

I think this is especially important if large dosages (several milligrams per day) of methylfolate and sublingual or injected methyl B12 are used, because this takes control of the rate of the methionine synthase reaction away from the cells and overdrives the methylation cycle. One result of this is that the folate levels rise rapidly, and cell division also rises rapidly. Under these circumstances, the normal supply of potassium from the diet may not be sufficient to supply the extra potassium that is needed. This is one reason why I do not favor taking high dosages of methylfolate and methyl B12 together by a person who has ME/CFS, but if a person chooses to do this, it is important that they monitor their blood potassium level and augment it as needed.

Note that over-the-counter potassium supplements are limited to 99 mg per pill. The reason for this is that if too much potassium is concentrated in one place in the digestive system, it can damage the wall of the digestive system.
It is preferable to take the potassium in the form of high-potassium foods or juices, or solutions of potassium salts, as tolerated.

Best regards,

Rich
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
My understanding is that if the slow-release tablets don't dissolve quick enough they can damage the digestive tract.
I think slow release potassium is designed to prevent damage to the digestive tract by minimizing high localized potassium concentrations such as found in the typical OTC 99 mg potassium gluconate.

Either way, it is a moot point if the only way to actually get the levels up is to use a slow release mechanism. Why bother taking potassium at all if it isn't going to raise your level significantly? For those not on potassium wasting drugs, OTC may be fine, but it's not enough for many others.
 

Lotus97

Senior Member
Messages
2,041
Location
United States
I think slow release potassium is designed to prevent damage to the digestive tract by high localized potassium concentrations such as found in the typical OTC 99 mg potassium gluconate.
I just posted what Rich said about the potassium pills right above your post. This is what Freddd said in response:
This warning applies to prescription time release forms of a non-disperable type that has 500mg in a single capsule/pill that can sit in a dissolving mass against the stomach causing tissue necrosis. It is not a hazzard of OTC capsules or fast dissolving low dose pills. But it is well worth warning. Also, don't take too much at a time. More smaller doses with a full gass of water are more effective and safer.
 

Victronix

Senior Member
Messages
418
Location
California
I was also surprised at the amount of potassium needed and it was scary -- how long will this go on??

But within a few weeks, I needed a little less, and that was a big relief. I think 2 weeks is the initial minimum amount of time you will need the most amount of potassium, and probably that could be longer depending on the individual. After that, things like exercise, hormonal changes like pms, stress, etc. can cause transient increased needs, but in the long run you will probably level out to a slightly decreased need, but not totally gone, if reports on here are correct. At least one person on here reported stopping needing it at all, but most continue to need it.

Looking back, I realize that I've probably needed more potassium all along, for the past several years, but was unaware that those symptoms were actually potassium deficiency. I'm resigned to the idea that it is a beneficial nutrient, not unlike Vit C or mfolate or mB-12, and I need to get it externally.

But to get to that point, you need to get comfortable with the method in which you take it.

I take it as a powder, NOW foods potassium gluconate. I carry around a container of powder and a 1/2 teaspoon measuring spoon along with my many other supplements, so that if necessary I can quickly dump that into a cup full of water and get relief within about a 1/2 hr. I had a potassium crisis happen suddenly when I went out on a (misguided) hike, thinking I didn't need to do more . . . having that container of powder was a lifesaver.

For me, a powder feels more comfortable because I can control it, the amount, when, etc., moreso than a tablet. Others may want to not have to think about taking it all the time.
 

Ema

Senior Member
Messages
4,729
Location
Midwest USA
I just posted what Rich said about the potassium pills right above your post. This is what Freddd said in response:
It's just not been my experience nor that of the many others I know that take slow release potassium.


Slow-K, potassium chloride extended-release tablets USP, is a sugar-coated (not enteric-coated) tablet for oral administration, containing 600 mg of potassium chloride (equivalent to 8 mEq) in a wax matrix. This formulation is intended to provide an extended-release of potassium from the matrix to minimize the likelihood of producing high, localized concentrations of potassium within the gastrointestinal tract.

http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=D22A9867-B638-4150-9DE4-CBC7D9398827
 

Victronix

Senior Member
Messages
418
Location
California
Yes, I wouldn't be surprised if some part of my potassium issues are to do with thyroid, given how hypothyroid will screw up digestion, metabolism, everything . . . . The StoptheThyroidMadness site can be over the top, but there is also often some useful info on there.

I note that Life Extension (where I do most of my labs myself) offers RBC Folate and RBC Magnesium, but not RBC Potassium, which is what that article recommends. I'd be interested in getting that tested somewhere if you know of a place. These articles that say "ask your doctor to test" . . . my immediate response is, "yeah, sure, right .. . that will never happen!"
 

Lotus97

Senior Member
Messages
2,041
Location
United States
Another thing. Make sure not to take potassium at the same time as methylfolate because it can block absorption of methylfolate in the gut. Vitamin C and iron can also block absorption too. I'm not sure if different types of vitamin C and/or potassium and/or nutrients from food all have the same effect. Freddd and dbkita have both talked about it so they will know more than me. I guess if you take methylfolate sublingually this isn't as much of a problem, but some if it's probably still absorbed intrinsically (in the gut) so I'm not sure. There was a discussion about this in another thread, but I don't remember the details.
 

NilaJones

Senior Member
Messages
647
I was also surprised at the amount of potassium needed and it was scary -- how long will this go on??

But within a few weeks, I needed a little less, and that was a big relief. I think 2 weeks is the initial minimum amount of time you will need the most amount of potassium, and probably that could be longer depending on the individual. After that, things like exercise, hormonal changes like pms, stress, etc. can cause transient increased needs, but in the long run you will probably level out to a slightly decreased need, but not totally gone, if reports on here are correct. At least one person on here reported stopping needing it at all, but most continue to need it.

Oh, I see. I was imagining that the need for potassium would be tied to the dosage of B12 and folate, and/or the level of methylation, and would just keep increasing.
 

NilaJones

Senior Member
Messages
647
Another thing. Make sure not to take potassium at the same time as methylfolate because it can block absorption of methylfolate in the gut. Vitamin C and iron can also block absorption too. I'm not sure if different types of vitamin C and/or potassium and/or nutrients from food all have the same effect. Freddd and dbkita have both talked about it so they will know more than me. I guess if you take methylfolate sublingually this isn't as much of a problem, but some if it's probably still absorbed intrinsically (in the gut) so I'm not sure. There was a discussion about this in another thread, but I don't remember the details.

Oh, dear, how many times a day am i supposed to eat?!

I am taking folate 4x a day (small doses, because more at once makes me nauseous). With potassium currently 5x a day, and if I need to take each one with food, that's looking like 9 meals a day now and more in the future. I am only out of bed for 8 hours.
 

NilaJones

Senior Member
Messages
647
New info!

I just now (as in, 10 minutes ago) got my MTHFR test results. I am neg for C677F and homozygous for A1298C. Is this why I heart Folapro?

My serum folate is listed as >22.3, B12 as 1500, vit D3-25 as 85.

At the time of testing I had been off folate 3 days, off B12 for a week or 10 days (I can look this up if needed, but an hurting too much right now), and was supplementing D3.

I would be so happy to have anyone's thoughts on interpreting these test results :).
 

Lotus97

Senior Member
Messages
2,041
Location
United States
Oh, dear, how many times a day am i supposed to eat?!

I am taking folate 4x a day (small doses, because more at once makes me nauseous). With potassium currently 5x a day, and if I need to take each one with food, that's looking like 9 meals a day now and more in the future. I am only out of bed for 8 hours.

You can take folate 20 minutes before a meal and potassium after a meal. Another option, if you take Solgar's Methyfolate (both Solgar and Folapro have Metafolin methylfolate) you can take it sublingually. It might still not be a good idea to take it right after your potassium since some of it will still be absorbed intrinsically.