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Constant tingling.. Maybe it is not Potassium deficiency?

Messages
49
So, since I jumped back in to a methyl protocol, about 1.5 weeks ago after a few week hiatus, I have near constant burning/tingling. What's confusing is that the burning and tingling is one of my dominant deficiency symptoms so it is hard to tell if I am not taking high enough dose to make the tingling go away or if the methylation is causing Potassium deficiency which I understand can cause itchy/tingling/burning skin.

I am currently taking 800mg-1600mg metafolin, B complex, 1000mcg methyl (Jarrow) and tons of co-factors.

Now, this morning I woke with no tingling, but by mid morning it arrived. I ate a banana and then took the folate. An hour passed, I took the B12 with some other food I am not remembering now. The tingling got a little worse. Then I ate about 14 oz of potatoes (somewhere around 2000mg potassium) and it didn't fix a thing. Certainly if such a high dose of potassium didn't make the tingling subside it has to be caused by something else?? Anyone have thoughts?!
 

Crux

Senior Member
Messages
1,441
Location
USA
Hi;
I suspect that the tingling is from B12 deficiency. I see you are taking a relatively high dose of folate, ( mcg.), compared to the B12. This could cause problems if the B12 dosage is too low.

I saw that you are wondering about the potency of Jarrow. It is now much less effective.

I suggest that you try Enzymatic Therapy brand, possibly in higher dosages.
 
Messages
49
Really? Hmm, the only reason I question this is that when I first started supplementing both B12 and folate back in January, my naturopath had me taking 4000mcg of folate and 1000 mcg B12. Within 2 weeks my months and months of tingling went away.. I started sleeping better, was in a better mood. It was like magic. Within 2 months I ran out of the supps and sort of got distracted and the symptoms started to return. I was intermittently taking some B12 lozenges, but nothing seemed to be doing the job. I finally bought all the supplements on Fredd's protocol and just started that a few days ago. So, that's the confusion.. Everything seems to indicate Potassium deficiency, but potassium doesn't seem to help. I can't imagine pushing my intake over 4000mg would make much difference.

Who knows. I guess I will just keep playing with the formula. I should note that I only have the methyl right now, still waiting on the adb12, maybe once I add that I will see some changes.

Also, considering I have the compound hetero for MTHFR, I wonder if that means I need more folate than some.
 

caledonia

Senior Member
Ordinarily, I would say it's methyl trapping like Crux is saying. But the higher dose of mfolate seemed to work better.

It's possible that you had somewhat of a reserve of B12, but the 4000mcg mfolate used that up and now you're deficient and getting methyl trapping.

Or you could be someone who needs that much mfolate. I've heard of one person who does well with a high amount like that. What are your MTR/MTRR SNPs like?

Another possibility is to try magnesium instead of potassium. That's how it works for me. (But I believe there is also some magnesium in the foods you ate?)
 

Red04

Senior Member
Messages
179
So, since I jumped back in to a methyl protocol, about 1.5 weeks ago after a few week hiatus, I have near constant burning/tingling. What's confusing is that the burning and tingling is one of my dominant deficiency symptoms so it is hard to tell if I am not taking high enough dose to make the tingling go away or if the methylation is causing Potassium deficiency which I understand can cause itchy/tingling/burning skin.

I am currently taking 800mg-1600mg metafolin, B complex, 1000mcg methyl (Jarrow) and tons of co-factors.

Now, this morning I woke with no tingling, but by mid morning it arrived. I ate a banana and then took the folate. An hour passed, I took the B12 with some other food I am not remembering now. The tingling got a little worse. Then I ate about 14 oz of potatoes (somewhere around 2000mg potassium) and it didn't fix a thing. Certainly if such a high dose of potassium didn't make the tingling subside it has to be caused by something else?? Anyone have thoughts?!

Muscle cramps and digestion are more tell tale signs of potassium. I believe the dietary potassium takes several hours to become effective. You may look at trying supplements before you rule out that it is potassium deficiency though. 3-4 X 99mg dosages every hour with a tall glass of water has worked for my wife. If you can tolerate the 4000mcg of methylfolate, I would hold that there and up the b12's with effective brands and try the potassium.

You might be somewhere in between steps 3 and 4 if you rule out potassium and had effective b12s. Note that the absorbed dosages are a lot lower than the actual sublingual dosages you would take to acheive that.

From Freddd:

1 - Titrate AdoCbl/MeCbl combo to approximately 100mcg absorbed where healing can "turn on" with 200-800mcg of l-methylfolate. 200mcg will not be enough and will immediately (3 days) give "detox" symptoms composed of low potassium and donut hole folate insufficiency. If startup does not occur by the time one gets to 1000mcg combined absorbed cobalamins, titrate LCF

2- Identify low potassium symptoms and titrate potassium.

3 - Identify donut hole folate insufficiency and titrate with 4x-8x dose size of l-methylfolate several times a day until those symptoms are strongly diminishing.

4 - titrate AdoCbl and MeCbl to perhaps a nominal sublingual dose of 1000mcg each, watching for low potassium, donut hole folate insufficiency and identify any other new symptoms, and what isn't being taken care of

5 - Finish titrating LCF to 500-1000mg for now, then identify what isn't healing or not enough. Try SAM-e, TMG, D- ribose, Vit D, Zinc, B-vits and various things as needed to improve performance. It isn't a try 1 thing and then another. It is add SAM-e and then TMG and various other things. It is usually combinations that yield results. SAM-e need titration over several months. LCF could take six months to titrate up to the 500mg dose and try 1000mg to see if it makes a difference. Don't rush things. Think things through. Look at the symptoms and effective supplements for them to get ideas. Most people will fall into one of several groups. Almost everybody here has appears to have complicating factors and more severe things going on, with me it is SACD which is basically long term damage from prolonged deficiency. Hormones get all messed up and will often change during these titrations.. There isn't a system of the body that is immune to damage from these deficiencies. As there are at least 600 reactions affected by the methylation and ATP the variations are huge in number.
 
Messages
49
Muscle cramps and digestion are more tell tale signs of potassium. I believe the dietary potassium takes several hours to become effective. You may look at trying supplements before you rule out that it is potassium deficiency though. 3-4 X 99mg dosages every hour with a tall glass of water has worked for my wife. If you can tolerate the 4000mcg of methylfolate, I would hold that there and up the b12's with effective brands and try the potassium.

You might be somewhere in between steps 3 and 4 if you rule out potassium and had effective b12s. Note that the absorbed dosages are a lot lower than the actual sublingual dosages you would take to acheive that.

From Freddd:

1 - Titrate AdoCbl/MeCbl combo to approximately 100mcg absorbed where healing can "turn on" with 200-800mcg of l-methylfolate. 200mcg will not be enough and will immediately (3 days) give "detox" symptoms composed of low potassium and donut hole folate insufficiency. If startup does not occur by the time one gets to 1000mcg combined absorbed cobalamins, titrate LCF

2- Identify low potassium symptoms and titrate potassium.

3 - Identify donut hole folate insufficiency and titrate with 4x-8x dose size of l-methylfolate several times a day until those symptoms are strongly diminishing.

4 - titrate AdoCbl and MeCbl to perhaps a nominal sublingual dose of 1000mcg each, watching for low potassium, donut hole folate insufficiency and identify any other new symptoms, and what isn't being taken care of

5 - Finish titrating LCF to 500-1000mg for now, then identify what isn't healing or not enough. Try SAM-e, TMG, D- ribose, Vit D, Zinc, B-vits and various things as needed to improve performance. It isn't a try 1 thing and then another. It is add SAM-e and then TMG and various other things. It is usually combinations that yield results. SAM-e need titration over several months. LCF could take six months to titrate up to the 500mg dose and try 1000mg to see if it makes a difference. Don't rush things. Think things through. Look at the symptoms and effective supplements for them to get ideas. Most people will fall into one of several groups. Almost everybody here has appears to have complicating factors and more severe things going on, with me it is SACD which is basically long term damage from prolonged deficiency. Hormones get all messed up and will often change during these titrations.. There isn't a system of the body that is immune to damage from these deficiencies. As there are at least 600 reactions affected by the methylation and ATP the variations are huge in number.

You know, even as a Bio major I have a hell of a time wrapping my head around some things that Fredd writes. I think his mind thinks linearly and mine works... well, non-linearly. Can you give me a overview of what exactly donut hole insufficiency means? Is it that the more you take, the more you need? At some point it levels and then you go back down?
 
Messages
49
Ordinarily, I would say it's methyl trapping like Crux is saying. But the higher dose of mfolate seemed to work better.

It's possible that you had somewhat of a reserve of B12, but the 4000mcg mfolate used that up and now you're deficient and getting methyl trapping.

Or you could be someone who needs that much mfolate. I've heard of one person who does well with a high amount like that. What are your MTR/MTRR SNPs like?

Another possibility is to try magnesium instead of potassium. That's how it works for me. (But I believe there is also some magnesium in the foods you ate?)

Yah, I suppose at this point anything is possible. I do supp Magnesium and have for about 2 years just because I think everyone is deficient. I generally take 200-400 mg chelate/day. And I try my hardest to get the most nutrient density of foods..

My SNPs are: MTRR A66G +/-, MTRR A664A +/-, MTHFR C677T, MTHFR A1298C.

Does that shed any light?

Like I mentioned, I am still waiting on the adb12.. so maybe that will help a little, but who knows. It wasn't this complicated the first time around. I had one serious Potassium crash a few weeks in.. but that was sever headache and nausea which resolved in a day or two. This time it is not nausea or headache, but intermitted fatigue and the ever present tingling! This morning so far I have eaten a banana and supplemented 2 x 99mg Potassium. Still tingles. The only other persistent symptom that I could potentially relate to Potassium is twitching in one eyelid which has been going on for about a week. It twitches so hard that others can see it.
 

Crux

Senior Member
Messages
1,441
Location
USA
All I know is that I must take a minimum of 5mg. Enzymatic Therapy methylcobalamin daily to prevent paresthesias and nerve death. No other supplement works for this sign of B12 deficiency.
 
Messages
49
All I know is that I must take a minimum of 5mg. Enzymatic Therapy methylcobalamin daily to prevent paresthesias and nerve death. No other supplement works for this sign of B12 deficiency.

If I may, how did you get here? Was that your first symptom? Did it just start suddenly? Do you have ME/CFS? I am always curious to know how people present and what steps they take before they reach diagnosis or solution. I was a vegetarian/vegan and super-duper partier for 15+ years. I can't imagine I was getting ANY B12 from food and what I was getting I was wasting due to alcohol abuse. In addition, I had those polymorphisms the entire time and of course didn't know. I was healthy.. like super healthy up until about 6 months ago. For me, Last August I got Shingles and after that the tingling and numbness set in. It was like the Shingles set it off. Of course, the b12 deficiency came before the Shingles and allowed it to take hold, but then somehow it set off a shit-storm. I am intrigued by the whole process.

Thanks for your input.
 
Messages
49
I am going to break down and get a potassium serum test tomorrow. They're only $29 through direct labs. Hopefully it can shed some light. Though Fredd claims that deficiency can occur with pretty high serum levels.. so maybe it will just confuse the issue further, but at least I'll have a point of reference.
 

Red04

Senior Member
Messages
179
You know, even as a Bio major I have a hell of a time wrapping my head around some things that Fredd writes. I think his mind thinks linearly and mine works... well, non-linearly. Can you give me a overview of what exactly donut hole insufficiency means? Is it that the more you take, the more you need? At some point it levels and then you go back down?

Basically, you have it right. You take enough metafolin to fire up healing and all of the sudden you need a lot more and get worse insufficency symptoms. If the theory is correct, then people get scared off from methylfolate because it makes them feel like $h*%. Eventually, you get past the donut hole and you need less. There is a gap in the middle where you need more. Like a donut.
 

Crux

Senior Member
Messages
1,441
Location
USA
Well, I'll give a go to the, " How Did I Get Here?", question.
Of course it's natural to wonder that, and I've suspected genetics as much as anything, because of the various health problems my family has had. ( I finally ordered a 23&me test.) There are additional genetic polymorphisms involved with B12 deficency than this test, but it'll probably be enough for me, maybe. I think the most recent discovery was a defect in the ABCD4 gene.

I can honestly say, with a laugh, that my first symptom was a loud flatus at birth, ( IBS-flatulence), because it became chronic from then on.

There were plenty of symptoms from childhood on, but I managed, though it was difficult. ( knew something was up.)
I had attention problems, and even fatigue, but like many, I thought it was because I needed to push more.

Brain Fog, among those in the know, is a neurological symptom. But I'll bring up that about 12 years ago, I began to drop things, I had trouble controlling my hand. Later, my feet. Then there were some vague paresthsias too.
( One doctor noticed I had enlarged red blood cells about 14 yrs. ago)

The most aggresive neuropathy began just before a big shingles outbreak. ( horrific pain with some numbness)

I haven't been diagnosed with ME/CFS, but I generally fit the symptoms. ( I've been improving alot.)
I have had alot of infections, and have been prone to them in life.

I was a vegetarian/ vegan for some years, and didn't eat many animal foods for some time after, but I don't believe my B12 deficiency was dietary induced, because, even with a high B12 diet, I still tanked.

There were some years, college etc., that I "acted out", but I had a low tolerance for drugs and alcohol. ( I could be found, barfing in the bushes.)

Many folks here recount that their ME/CFS began when they did not recover from an infection; whether it be of a bacterial, viral, fungal, or parasitic type.

It looks like with us, the Herpes Varicella Zoster virus took us down.
 
Messages
49
Interesting, thanks for sharing. It seems to me like the B12/viral thing is so deeply connected. I have a sense that the broken methyl cycle leaves us especially prone to viral infections. I just posted a new thread about the b12/folate deficiency and viral connection as I just learned that I have one of the many forms of HPV. Go figure.

I found this interesting study that relates the 2 deficiencies to HPV 16, one of the high risk forms.

It is especially interesting to me because I don't even get so much as the common cold, but yet I have an issue with dormant/silent viruses. I am hoping that kicking my methyl cycle into high gear will help to stamp out these issues.
 

Lotus97

Senior Member
Messages
2,041
Location
United States
thegiantess
For some reason the quality of Jarrow's methylcobalamin has become very poor since around summer 2012. Enzymatic Therapy is the best brand of methylcobalamin (as far as what has been tested). After that, maybe Solgar or AOR, but there's no reason not to take Enzymatic Therapy's methylcobalamin unless you're rotating brands which some people do if they develop a tolerance to one brand.
 

triffid113

Day of the Square Peg
Messages
831
Location
Michigan
So, since I jumped back in to a methyl protocol, about 1.5 weeks ago after a few week hiatus, I have near constant burning/tingling. What's confusing is that the burning and tingling is one of my dominant deficiency symptoms so it is hard to tell if I am not taking high enough dose to make the tingling go away or if the methylation is causing Potassium deficiency which I understand can cause itchy/tingling/burning skin.

I am currently taking 800mg-1600mg metafolin, B complex, 1000mcg methyl (Jarrow) and tons of co-factors.

Now, this morning I woke with no tingling, but by mid morning it arrived. I ate a banana and then took the folate. An hour passed, I took the B12 with some other food I am not remembering now. The tingling got a little worse. Then I ate about 14 oz of potatoes (somewhere around 2000mg potassium) and it didn't fix a thing. Certainly if such a high dose of potassium didn't make the tingling subside it has to be caused by something else?? Anyone have thoughts?!
I get tingling/pain all over when I am hypothyroid. And here is something I just found today at www.thyroidmanager.org: Cobalt. Cobalt inhibits iodide binding by the thyroid.105 The mechanism is unknown. Cobalt deficiency is associated with a reduction in type I monodeiodinase activity and a fall in T3105a while cobalt excess may produce goiter and decreased thyroid hormone production. 105b It is sufficiently active to have been used in the treatment of thyrotoxicosis.106

Hair analysis showed me to be high in cobalt. You can get your hair analysed at www.traceelements.com via www.evenbetternow.com for $100 if you like. Anyway I was not high in cobalt when I was 45. Somewhere along the line I became high in cobalt. The only thing I can think I could get cobalt from is B12 pills! It personally does not affect my thyroid that much...but www.lef.org says your TSH is not right unless TSH<2.0 and the best I can get mine now is 2.3 so it is a little off caused possibly by the cobalt or possibly by the fact that I take broccoli pills and broccoli is a goiterogen. However I do not get tingle/burn (what it feels like is that my tissues are not getting something vital they need, like oxygen, or maybe even like I have cancer) unless my thryoid is much worse than 2.3. In fact I know so far it has to be worse than 3.2 (not sure how much worse) before I get that symptom. I also get a unilateral headache from hypothyroid of that greater level. Basically, check your thyroid. Not against standard reference range, which means nothing. Check here for info on HEALTHY TSH range: www.lef.org/appendix/protocols/blood_testing_02.htm
 

triffid113

Day of the Square Peg
Messages
831
Location
Michigan
Well, I'll give a go to the, " How Did I Get Here?", question.
Of course it's natural to wonder that, and I've suspected genetics as much as anything, because of the various health problems my family has had. ( I finally ordered a 23&me test.) There are additional genetic polymorphisms involved with B12 deficency than this test, but it'll probably be enough for me, maybe. I think the most recent discovery was a defect in the ABCD4 gene.

I can honestly say, with a laugh, that my first symptom was a loud flatus at birth, ( IBS-flatulence), because it became chronic from then on.

There were plenty of symptoms from childhood on, but I managed, though it was difficult. ( knew something was up.)
I had attention problems, and even fatigue, but like many, I thought it was because I needed to push more.

Brain Fog, among those in the know, is a neurological symptom. But I'll bring up that about 12 years ago, I began to drop things, I had trouble controlling my hand. Later, my feet. Then there were some vague paresthsias too.
( One doctor noticed I had enlarged red blood cells about 14 yrs. ago)

The most aggresive neuropathy began just before a big shingles outbreak. ( horrific pain with some numbness)

I haven't been diagnosed with ME/CFS, but I generally fit the symptoms. ( I've been improving alot.)
I have had alot of infections, and have been prone to them in life.

I was a vegetarian/ vegan for some years, and didn't eat many animal foods for some time after, but I don't believe my B12 deficiency was dietary induced, because, even with a high B12 diet, I still tanked.

There were some years, college etc., that I "acted out", but I had a low tolerance for drugs and alcohol. ( I could be found, barfing in the bushes.)

Many folks here recount that their ME/CFS began when they did not recover from an infection; whether it be of a bacterial, viral, fungal, or parasitic type.

It looks like with us, the Herpes Varicella Zoster virus took us down.
P.S. If you eat a low protein diet, B12 is not the only concern, but also tyrosine and zinc, required by the thyroid. I take 1-3g tyrosine/day by doctor's orders. I take zinc in massive quantities when I have allergy/cold/nasal infection of any kind (it is required to rebuild damaged mucous membranes). Just to be aware, the thyroid also needs selenium, iodine, and copper. Maybe other stuff.
 
Messages
49
I get tingling/pain all over when I am hypothyroid. And here is something I just found today at www.thyroidmanager.org: Cobalt. Cobalt inhibits iodide binding by the thyroid.105 The mechanism is unknown. Cobalt deficiency is associated with a reduction in type I monodeiodinase activity and a fall in T3105a while cobalt excess may produce goiter and decreased thyroid hormone production. 105b It is sufficiently active to have been used in the treatment of thyrotoxicosis.106

Hair analysis showed me to be high in cobalt. You can get your hair analysed at www.traceelements.com via www.evenbetternow.com for $100 if you like. Anyway I was not high in cobalt when I was 45. Somewhere along the line I became high in cobalt. The only thing I can think I could get cobalt from is B12 pills! It personally does not affect my thyroid that much...but www.lef.org says your TSH is not right unless TSH<2.0 and the best I can get mine now is 2.3 so it is a little off caused possibly by the cobalt or possibly by the fact that I take broccoli pills and broccoli is a goiterogen. However I do not get tingle/burn (what it feels like is that my tissues are not getting something vital they need, like oxygen, or maybe even like I have cancer) unless my thryoid is much worse than 2.3. In fact I know so far it has to be worse than 3.2 (not sure how much worse) before I get that symptom. I also get a unilateral headache from hypothyroid of that greater level. Basically, check your thyroid. Not against standard reference range, which means nothing. Check here for info on HEALTHY TSH range: www.lef.org/appendix/protocols/blood_testing_02.htm

Hi thanks for your thoughts. My TSH has fallen between 1.0-1.4 for the past 3 years... so I don't think that's the problem.
 
Messages
49
Muscle cramps and digestion are more tell tale signs of potassium. I believe the dietary potassium takes several hours to become effective. You may look at trying supplements before you rule out that it is potassium deficiency though. 3-4 X 99mg dosages every hour with a tall glass of water has worked for my wife. If you can tolerate the 4000mcg of methylfolate, I would hold that there and up the b12's with effective brands and try the potassium.

You might be somewhere in between steps 3 and 4 if you rule out potassium and had effective b12s. Note that the absorbed dosages are a lot lower than the actual sublingual dosages you would take to acheive that.

From Freddd:

1 - Titrate AdoCbl/MeCbl combo to approximately 100mcg absorbed where healing can "turn on" with 200-800mcg of l-methylfolate. 200mcg will not be enough and will immediately (3 days) give "detox" symptoms composed of low potassium and donut hole folate insufficiency. If startup does not occur by the time one gets to 1000mcg combined absorbed cobalamins, titrate LCF

2- Identify low potassium symptoms and titrate potassium.

3 - Identify donut hole folate insufficiency and titrate with 4x-8x dose size of l-methylfolate several times a day until those symptoms are strongly diminishing.

4 - titrate AdoCbl and MeCbl to perhaps a nominal sublingual dose of 1000mcg each, watching for low potassium, donut hole folate insufficiency and identify any other new symptoms, and what isn't being taken care of

5 - Finish titrating LCF to 500-1000mg for now, then identify what isn't healing or not enough. Try SAM-e, TMG, D- ribose, Vit D, Zinc, B-vits and various things as needed to improve performance. It isn't a try 1 thing and then another. It is add SAM-e and then TMG and various other things. It is usually combinations that yield results. SAM-e need titration over several months. LCF could take six months to titrate up to the 500mg dose and try 1000mg to see if it makes a difference. Don't rush things. Think things through. Look at the symptoms and effective supplements for them to get ideas. Most people will fall into one of several groups. Almost everybody here has appears to have complicating factors and more severe things going on, with me it is SACD which is basically long term damage from prolonged deficiency. Hormones get all messed up and will often change during these titrations.. There isn't a system of the body that is immune to damage from these deficiencies. As there are at least 600 reactions affected by the methylation and ATP the variations are huge in number.

Hi there Red,

Just thought I would give an update since you have been so kind with your thoughts with a lot of my questions. I caved and got a serum Potassium test, came back at 4.2 with lab range 3.5-5.2. Now that is with tracking potassium in Fitday and aiming for 4000 mg from food and taking an additional 3 x 99mg supps. I can't imagine how low it would be if I were not doing that. On Friday evening I did start to experience gastric upset, and what felt like stomach cramping. I forced food down and it finally mellowed out. But then Saturday it was the same... my guts felt sore and the muscle spasms continued. Yesterday I woke with a terrible headache... All of these things point to low potassium. I was hoping that my serum would show much lower than 4.2 so I could be sure it is potassium we are dealing with, but I would expect it to be much higher from all the food and supplements in the absence of forced methylation.

Also, I noticed that on my most recent and all my old serum tests, my Alkaline Phosphatase shows on the very low end of range. Like I think the low end is 30 and I am at 32 out of 150. I did a quick google and it looks like that can be because of B12 or B6 deficiency. Interesting.

Everyone keeps saying the Jarrow formula is no good, but if it weren't working for me I would expect my paraesthesia to return, but it has not. I wonder if it works just enough for me? Who knows, I will switch to Enzymatic Therapy just to be safe.

Any thoughts you might have on my Potassium reading would of course be welcome.
 

Calathea

Senior Member
Messages
1,261
99mg potassium tablets are pretty insignificant - have you tried using salt replacements in water instead? I need a lot of salt, so I simply put low-sodium salt into my water bottle and that provides me with both sodium and potassium. Much cheaper than all those tablets too.
 

Red04

Senior Member
Messages
179
It is my understanding that a serum potassium test in useless when starting methylation.....Simply because it can vary so much in a matter of a few hours. You would need to do several potassium blood tests over the course of 24 hours, while going through the potassium deficiency symptoms to be sure.

I think there may be some way to get a home test kit, but I don't recall anyone on here effectively using one.

And yes, all your symptoms would point to potassium deficiency. You should be able to titrate the potassium deficiency symptoms away. If more doesn't stop them, it may be something else. I never counted dietary potassium as part of the equation. That was normal potassium in my mind and the "supplementation" came from the supplements. Using 3500-4700 as a reference, I was not afraid to actually "supplement" 1600-2000mg while experiencing what I perceived as potassium deficiency symptoms. I can tell you 3x99mg was not enough for my wife. Exercise and activity can have a large impact on the potassium demand too.