Low potassium symptoms?

[Mary]

Do you also need to hold the sublingual under your tongue for an extended period like 90-120 minutes?

No - I only have to hold the liquid methylcobalamin under my tongue for a short period of time. I think it's rapidly absorbed, unlike the sublingual tablets which I was never patient enough to let fully dissolve and absorb --

 

[Katy131]

Do you also need to hold the sublingual under your tongue for an extended period like 90-120 minutes?

Hi Tina - When I was taking thyroid meds years ago, I took them "sublingually" which my doctor said didn't need to be actually under the tongue. I lodged them between my gum and my lower lip while they dissolved over an hour or so. I totally forgot about them and was still able to talk and drink etc. Hope this helps

 

[Katy131]

I've seen people talk about how potassium helps the extreme fatigue you get when starting your methylation programme, but what symptoms do you get? Mine include nausea, loss of appetite and stinging and aching in my head arms and legs, as well as terrible back ache like a normal person might get after a long day.

Also, I've been taking potassium gluconate (99mg) for about a week and worked up to @Mary 's level of 2 with each meal and 2 at night, plus one in the middle of the night as well as two glasses of coconut water a day, and the symptoms are much better but not gone and I'm wondering if I should continue to titrate up until they are all gone? My blood pressure has reduced happily to 127/75 so that's another good side effect but I am still concerned about taking too much. Thoughts?

 

[TinaT]

two glasses of coconut water

How big are your glasses? How many ounces? My concern with coconut water is the calories.

what symptoms do you get?

I get louder tinnitus, totally bloated stomach like food stops moving (usually later in the day, like after dinner esp), usually low BP (sometimes very high BP), and extreme and unusual tiredness but like if you let yourself just fall asleep -- it feels more like passing out. Not a good thing. I guess maybe a reduction in appetite... Though I eat on schedule regardless.

and I'm wondering if I should continue to titrate up until they are all gone? My blood pressure has reduced happily to 127/75 so that's another good side effect but I am still concerned about taking too much. Thoughts?

I constantly wonder the same thing. You might want to try low sodium V8. I drank 3 glasses the other day and my symptoms improved more (still not gone). But I can't handle the V8 bc I still have reflux and that stings my throat and gets worse and worse.

You have a better system already than I do. I'm still too scared to take potassium unless and until I get symptoms, esp since I'm still trying to figure out the best methylfolate dose. So my first symptom is usually feeling like I'm so tired I'm going to pass out, or very loud Tinnitus. These are not good bc I think I'm getting down to severely low potassium every day, before I take potassium. I'm guessing that is not good for my health.

That being said, since you are comfortable with 200 at a time, maybe try 300? I took some comfort in the fact that potassium leaves the body (well half-life) in 1.5 to 2 hrs. If you use powder, you can slowly drink so that you can gauge your reaction. That's still what I do with every "dose."

Also if you can handle acidic stuff, I loved seeking health electrolyte drink in the morning (550 mg of potassium and low calorie). I just can't handle it bc if the reflux.

Also life extension buffered C (300 potassium), which I took for a few days at the same time as the electrolyte drink (or right after).

I always feel more comfortable with mixes, electrolyte drinks, coconut water, V8, etc. I just wish I could find something low calorie and not acidic. I don't think that product exists. I did find alkaline electrolyte drinks, but they have stevia, and that can cause bloating. So I stopped those, too, because bloating is one of my biggest problems, and what I'm hoping the B12 will correct.

I would love to hear from others about how they got the confidence to add even more potassium.

I'm also still wondering whether my ongoing bloating is potassium, methylfolate (not enough), the B12 deficiency still not better, or something else entirely.

Please keep everyone posted on your progress! I'm following this thread and really trying to figure this out as I go, just like you.

 

[Mary]

Also, I've been taking potassium gluconate (99mg) for about a week and worked up to @Mary 's level of 2 with each meal and 2 at night, plus one in the middle of the night as well as two glasses of coconut water a day, and the symptoms are much better but not gone and I'm wondering if I should continue to titrate up until they are all gone? My blood pressure has reduced happily to 127/75 so that's another good side effect but I am still concerned about taking too much. Thoughts?

@Katy131 - it might help to know that the daily RDA for potassium for an adult is 4700 mg. So the 1000 mg I've been taking is 25% of the RDA. It sounds like you're taking close to 2000 mg a day.

Unfortunately no one here can tell you how much to take - that would fall under the category of giving medical advice which we're not allowed to do. However, others can tell you how much they're taking - I've seen people take quite a bit more than me, and some do well with a lot less.

All I can suggest is to go slowly and pay attention to how you're doing, and it sounds like you're already doing that. I do think that for most healthy people it's difficult to get too much potassium from food sources. I think people with kidney problems are the ones most likely to have problems with too much potassium as their kidneys cannot filter it properly.

btw, have you tried low-sodium V-8 for potassium? Just another source of potassium you might consider -

 

[TinaT]

Unfortunately no one here can tell you how much to take - that would fall under the category of giving medical advice which we're not allowed to do. However, others can tell you how much they're taking - I've seen people take quite a bit more than me, and some do well with a lot less.

I was just going to share that I just tried taking 200 with my morning supps. If I take potassium alone, without waiting for symptoms, that causes my BP to drop. I'm guessing bc I'm mostly plant based (high potassium) diet already -- and have a relatively low BP to start (my normal is 115/68).

So I'm in a real mess bc sometimes potassium lowers my BP too much, and sometimes (usually at night when I'm feeling like I'm going to pass out) potassium raises my BP.

But I have to sip slowly and check my BP while doing so. Because it can vary.

I would say that probably today's lesson is that if I'm feeling alert and have good BP -- it's probably not a good idea for me anyway to take potassium in anticipation of having low K later in the day. Because at those times -- potassium drags me down.

It's very perplexing and and absolutely, definitely no good way to live long-term -- I'm really worried that this is my new way of life -- constantly needing to experiment with potassium. Some sources say that the low potassium mainly happens "in the beginning" of B12 injection therapy. I'm not sure what duration constitutes the beginning, but I really hope this improves soon.

I definitely respond the best to mixtures that include sodium and other nutrients but still can have similar reactions depending.

I agree that higher doses mostly seem fine -- but for me these are always in the form of electrolyte mixes, V8, or coconut water. The other thing is that how much potassium in your existing diet would seem relevant.

 

[TinaT]

I guess another idea is to sip slowly, like over half hour, and check you BP as you go. Also your alertness is an indicator. I think those gradually change if you sip K or even like an electrolyte drink or coconut water. But what a frustrating way to live -- hard to do anything else if you can't just know what you should take on any given day.

For me anyway, if I've taken too much, my BP starts to drop too much, and I get really tired. Unfortunately those are the same symptoms (I think) as when I ignore potassium all day, then have (I think) extremely low potassium at night -- at which point potassium raises my BP, and my tiredness goes away. That's what happened last night. But this morning -- when feeling fine and totally alert -- potassium brought me down (tiredness / low BP).

Anyway my point is that at least my experience is that adding potassium slowly while measuring BP and tiredness versus alertness -- has been at least short-term safe for me (though really, really horrible as far as quality of life!!)

 

[TinaT]

Unfortunately no one here can tell you how much to take - that would fall under the category of giving medical advice which we're not allowed to do. However, others can tell you how much they're taking

Hey Mary. That makes complete sense. I understand no one can tell us how much to take. I can tell that's clearly a very personal question anyway.

I still very much appreciate you and others explaining your decision making, responses, dosages, and any other details that might help. This is such a difficult problem. I can't believe more doctors aren't aware of not just B12 but then how to deal with this reaction to injections. Maybe that's why they advise lower B12 doses over a longer period of time? (And that advice varies so much, too.)

I can share that my doctor said that 750 mg of potassium chloride morning and night would be safe given my average when testing potassium of around 4.1 - 4.3. He actually prescribed that amount. However, I haven't taken the med, and I'm pretty sure based on my reaction this morning to 200 mg, I would not feel very good if I took that much in the morning anyway. But his point was that potassium can safely be much higher than where my average sits -- so I can safely afford to add that much, in his opinion. I can also say that on days where I took even more than 1500, I felt better, but I still took based on how I was feeling

And I definitely need more if I exercise -- current plan to try (which has worked well before but not always) is drinking coconut water during any exercise -- since the calories would be less of an issue, and I need more on those days anyway -- really sucks though that I've cut back exercising significantly bc of this problem -- where K is just too low at night, if I've exercisesd that day. But i can't give up completely. I just don't think that's healthy either.

. Your situation might be different.

Mary, could you (or anyone reading) please share whether you took enough to feel like you had no potassium issues? In other words, did you keep increasing the dose until everything seemed good like not constipated, alert, and with a good BP? Or so you stay slightly under, too?

And I assume this improved with time. Do you know how long the worst of your low potassium continued, after you started B12 injections?

 

[Katy131]

How big are your glasses? How many ounces? My concern with coconut water is the calories.

I'd say a glass is 200 ml (I'm in the UK so not sure what that is in ounces). That's 36 calories a glass and 376 mg Potassium, according to the pack. I'm not too concerned about calories. My weight is stable at the top of the "normal" range and I eat a very good diet, cook from scratch daily, don't eat ultra processed foods and get 30+ fruits and vegetables in my diet in a week, so I think I'm doing OK!

That being said, since you are comfortable with 200 at a time, maybe try 300? I took some comfort in the fact that potassium leaves the body (well half-life) in 1.5 to 2 hrs.

That's so helpful - thank you! I find that very comforting too. Yes I guess going slow and listening is the way to go - guess I just needed some reassurance from what others are doing/finding.

Also if you can handle acidic stuff, I loved seeking health electrolyte drink in the morning (550 mg of potassium and low calorie). I just can't handle it bc if the reflux.

Also life extension buffered C (300 potassium), which I took for a few days at the same time as the electrolyte drink (or right after).

I always feel more comfortable with mixes, electrolyte drinks, coconut water, V8,

Sadly, being in the UK, most of these brands aren't available here, but I take some comfort from the fact that I'm already taking a full dose of Sunshine Salt daily which contains all the electrolyte minerals including Vitamin D3 and B12 as well!

I'm also still wondering whether my ongoing bloating is potassium, methylfolate (not enough), the B12 deficiency still not better, or something else entirely.

I used to have a lot of bloating til I sorted out the Candida overgrowth last year, but that's another story. Have you looked into that?

Please keep everyone posted on your progress! I'm following this thread and really trying to figure this out as I go, just like you.

Will do! Thank you so much for the welcome

 

[Katy131]

it might help to know that the daily RDA for potassium for an adult is 4700 mg. So the 1000 mg I've been taking is 25% of the RDA. It sounds like you're taking close to 2000 mg a day

Yes, thank you, I've read about the RDA a lot here and it is reassuring, but it doesn't take account of what potassium someone gets from their diet too and that's more difficult to calculate. By my calculation, I'm taking 1643 mg a day ( 9 x 99 from the supps and 375mg x 2 for the two glasses of coconut water). Have I missed something?

I'm thinking I probably do need to increase a little more - I had a good reduction in symptoms once I got up to my current dose a few days ago but symptoms are increasing again so perhaps my body is using what I'm giving it and needs more ...

Do you recall what specific symptoms you got from the low Potassium fatigue in the beginning, @Mary ?

 

[Katy131]

I can share that my doctor said that 750 mg of potassium chloride morning and night would be safe given my average when testing potassium of around 4.1 - 4.3. He actually prescribed that amount. However, I haven't taken the med, and I'm pretty sure based on my reaction this morning to 200 mg, I would not feel very good if I took that much in the morning anyway. But his point was that potassium can safely be much higher than where my average sits.

Thanks for another really reassuring piece of info! By that token, I'm taking about that already (1643 mg) per day and my testing Potassium in November was at 3.9, so I feel reassured that increasing a little more would be OK for me.

By the way, I'm still only at the beginning of my methylation "journey". I'm only at the stage of supplementing P5P B6 together with a multi which contains active B2, B6 and methylated B12 and folate which is already giving me these strong symptoms :/ Haven't even started on additional B12 or folate. More about my background and the protocol I am following in my first post here:

https://forums.phoenixrising.me/thr...-cobalamin-and-other-questions-discuss.89850/

 

[Mary]

I'm thinking I probably do need to increase a little more - I had a good reduction in symptoms once I got up to my current dose a few days ago but symptoms are increasing again so perhaps my body is using what I'm giving it and needs more ...

This is quite possible. Like I said, there are people here who take or have taken quite a bit more than I do (and also less of course). Again, I think it's good to go slow, increase gradually and see what happens.

Do you recall what specific symptoms you got from the low Potassium fatigue in the beginning, @Mary ?

My first specific symptom was severe fatigue. I just felt yucky, very low energy, maybe woozy too - it's hard to remember exactly. but it hit so soon and so hard after starting the methylfolate, I was sure there was a connection. And also, the symptoms abated rather quickly once I got enough potassium in my system.

Also, another symptom which hit me for several years after starting the methylolate was muscle spasms and twitches in my feet and lower calves, particularly in the middle of the night. Sometimes they were quite painful. This is a common symptom of low potassium. It would hit during the day as well, I'd notice one of my feet starting to twitch and realize that my potassium had gotten low again, even if I'd been taking my regular dose. Usually a glass or 2 of low-sodium v-8 would be enough to stop this.

I think I posted this before but don't want to look it up right now - here are common symptoms of low potassium: https://www.healthline.com/nutrition/potassium-deficiency-symptoms And I'm sure there are more symptoms -

 

[Mary]

Your situation might be different.

Well, it's different in that I'm not able to exercise due to ME/CFS . I'm limited to roughly 4 hours a day of light activity to avoid crashing (PEM) the next day. I've been this way since 1998. I've improved in a lot of ways thanks to a ton of experimentation but have not been able to noticeably increase my energy envelope!

Mary, could you (or anyone reading) please share whether you took enough to feel like you had no potassium issues?

I found that 1000 mg divided throughout the day and evening was enough to ward off low potassium issues and so I just kept it up for many years and did well with this dose. Potassium never gave me low blood pressure. It sounds like you have a few other things going on which make your situation more complex. I seem to be pretty straightforward in dealing with things - nothing too complicated! So I really don't know how to respond here. I think I mentioned in a previous post how much muscle testing (by competent experienced practitioner) helped me - that's all I can think of.

And I assume this improved with time. Do you know how long the worst of your low potassium continued, after you started B12 injections?

Actually I started in reverse. I took B12 orally and then did injections and then sublingually etc and didn't get symptoms of potassium deficiency THAT I WAS AWARE OF. I didn't know anything about low potassium when I first started with B12. My doctor didn't either. He knew a lot, he was good, but this was before potassium issues and starting methylation was a well-known quantity. Anyways, to my knowledge my low potassium issues didn't start until I started taking methylfolate in 2010. And the severe fatigue started within a couple of days. Once I titrated up to an effective dose of potassium over a couple of days, the severe fatigue abated, and I found I had to stay at that dose (1000 mg. divided doses) for many years thereafter. I've only recently cut back a bit but am going back up. It's a long story I won't go into here.

 

[TinaT]

Anyways, to my knowledge my low potassium issues didn't start until I started taking methylfolate in 2010

I assume you notice benefits from methylfolate that make it worth taking?

Well, it's different in that I'm not able to exercise due to ME/CFS

I'm sorry about that. I guess I must seem not very sick. All I can say is that I can barely eat anything. I sleep sitting almost straight up, wearing a neck collar. I haven't had sex with my husband in many months as a result. I have to blend a lot of my food.

I also had PEM when I joined this forum. Thankfully, at least so far, B12 and iron have improved that situation. I can recover and sleep now. However -- my severe abdominal distension was getting worse. I have a ureaplasma infection that many people need extended antibiotics to treat. I probably have SIBO and an getting tested soon for h pylori (with some classic symptoms). I can't tolerate antibiotics so I'm trying natural remedies that aren't likely to work. I'm pretty screwed. And I guess iron makes infections worse so I stopped those for now.

My throat and mouth constantly hurt.

I sometimes can't take straight potassium for some reason. Makes me feel like I'm going to have a heart attack or fade out or something.

And the low BP (low iron can cause this). My BP was fine before I started B12 injections. Cleveland clinic website says that severely low K can cause low BP. I guess methylfolate can cause low BP. Etc. So I'm trying with potassium. If that doesn't work soon, I'll need to reduce my methylfolate dose bc I can't live this way voluntarily.

So, at least for me, yes, I can run. But if you can eat pizza or chocolate cake or Mexican or Thai or about a hundred other good foods -- then you can do something that I'm constantly depressed about not being able to do.

And with a huge stomach, which was flat last year, running and fitness are starting to feel less valuable. And they make my potassium crash then need to drink more calories anyway...

Just so I'm clear that I'm not just on easy street over here.

I've been in medical hell for about 3 years with no end in sight. I can't imagine how you must feel dealing with serious issues since 1998.

For me, things have only gotten worse with time, and the B12 (or methylfolate) has made my overall symptoms BY FAR the worst yet. But having improved tinnitus, reflux, and sleep -- gives me reason to keep trying with this protocol.

 

[Katy131]

Just so I'm clear that I'm not just on easy street over here.

I'm so sorry to read your symptoms and how it's affecting your life. A big from over here across the Pond

I've also got multiple food allergies to the point where I no longer enjoy eating out, which I used to love, and almost live on Benadryl which is a lifesaver when I get a reaction - shortens the length of the reaction and also reduces the intensity a bit. So I have some understanding of your food problems.

And with a huge stomach, which was flat last year, running and fitness are starting to feel less valuable. And they make my potassium crash then need to drink more calories anyway...

You also say you can't tolerate antibiotics. These make me think you may have a problem with Candida like I have had. Have you been tested for Candida overgrowth? It's made a huge difference to me, normalising my weight and making eating more enjoyable.

Another thing which springs to my mind is low magnesium, which I haven't seen much mentioned here in the Methylation threads. I had chronic low magnesium (tested in Red Blood Cells, not Serum) which seriously contributed to my symptoms over many years and it was hard to get it into the normal range with oral supplements alone. I got it back into the normal range last year by nebulising magnesium sulfate daily, and I think lack of sufficient magnesium may also be part of my current strong fatigue, pain and nausea symptoms while on the Methylation protocol. I just nebulised 0.5g this morning and an hour later feeling quite a bit of relief! (Watch this space! lol) Dr Myhill has a very helpful page on low magnesium which may be worth a look.

https://www.drmyhill.co.uk/wiki/magnesium_-_treating_a_deficiency

 

[Mary]

@TinaT - I can't imagine dealing with everything that you have to. No, I wasn't thinking that you don't seem sick at all - I was just pointing out a difference between you and me. I really hope you get some answers soon!

I assume you notice benefits from methylfolate that make it worth taking?

I started taking methylfolate in 2010 (I had started crashing in 1998). Within 2 days the methylfolate had given me energy which I had not had in 12 years - it felt like a miracle, so I've been taking it ever since, along with potassium.

I still wonder about your SIBO. Has anyone checked your stomach acid levels? Stomach acid is necessary to keep harmful bacteria in check and low stomach acid can give rise to SIBO. There's lots of info out there about this. A quick and simple home test which can give some indication of whether you have enough stomach acid is this:

The baking soda test​

The theory behind this at-home is that baking soda combined with stomach acid produces carbon dioxide (C02), which will cause you to burp. For the test, you’ll drink half a glass (4 ounces) of cold water combined with a quarter teaspoon of baking soda, on an empty stomach. Then time how long it takes you to burp. If it takes longer than three to five minutes, the theory goes, you don’t have enough stomach acid.

https://my.clevelandclinic.org/heal... the test, you'll,t have enough stomach acid.

 

[Katy131]

Please keep everyone posted on your progress! I'm following this thread and really trying to figure this out as I go, just like you.

Update! My symptoms have all disappeared (fingers crossed) since I added in approx 1500 mg Potassium (as described above) and restarted nebulising 1.0g Magnesium Sulfate daily and topping up as necessary with Magnesium Taurate. I was even able to return to Curves gym yesterday after several weeks of barely being able to leave the sofa. Thanks to everyone here who has helped with information! I'm now considering adding in the next stage in the protocol.

Question: As I start to add in further elements (I guess the next stage would be some methyl folate), if symptoms start up again, I wonder if I will likely need to increase Potassium some more to cover? What are your experiences?

Second question: Would it be better to start with and establish a dose of Phosphatidyl Serine before adding in other elements? I'm unclear if that is likely to cause more symptoms or conversely support the additions of the other elements. Thoughts?

 

[TinaT]

Question: As I start to add in further elements (I guess the next stage would be some methyl folate), if symptoms start up again, I wonder if I will likely need to increase Potassium some more to cover? What are your experiences?

I have started to recognize the symptoms of each deficiency (some overlap -- like constipation and tiredness -- which is frustrating).

For me, folate deficiency includes the
very distinct symptom of sores on the sides of my tongue. That was confusing bc it feels very similar to reflux -- which was my worst B12 deficiency symptom. But the sores on tongue are visible and do actually feel different than reflux (similar pain in different spot).

I'm glad you are feeling better. I've continued to have serious problems with low blood pressure. I think I've finally figured out that is most likely caused by my low ferritin (which I already had before starting B12 injections, but, like potassium, B12 eats up iron, making my ferritin most likely even lower).

That would be great news (bc in theory I could just take iron) except raising ferritin is a huge challenge with gut health issues and, for various reasons, I don't think I would react well, at all, to iron infusions (which is what the hematologist wants me to do).

I figured this out bc my BP gets higher for most of the day after taking iron. And doesn't on days when I don't. Plus low BP and hypoxia are low iron symptoms -- and I think I've had both -- which is really scary.

I also think sometimes the low BP is made worse by potassium (bc when I drink potassium my levels usually go up -- but not always -- so I'm trying to figure out the exact symptoms -- usually extreme muscle twitching and constipation, with low BP, mean low potassium; low BP without the other symptoms -- my guess is low iron).

I do take magnesium and don't think that's an issue for me.

Two days ago -- in addition to drinking more coconut water during the day, I decided that I have to space my B12 injections further apart. I'm trying every other day and will space even further if I can't raise my nighttime BP. I'm also trying even harder on iron -- but I was already trying so that's a sticky sticking point for me.

I did start to develop worsening symptoms as my duration of doing the injections increased, and I just read that is common. I was trying to push through but I have to draw the line at my heart beating! Even though I didn't inject yesterday -- I still woke up with BP of 88/62! That ER level BP.

I have an unrelated vaginal infection and just started iodine drops for those. Iodine can raise BP. So I'm hoping that might be an unintended positive side effect!!

I hope your progress continues onward and straight upward!

(Also sorry I didn't reply to your previous comments -- I had a nice break with a long beach weekend, now just trying to get myself back into figuring out this whole mess again ).

 

[TinaT]

Never had twitching, and I thought that was from magnesium deficiency?

I'm not sure about magnesium deficiency symptoms. But I take enough magnesium and B12 injections are known to cause potassium deficiencies. So that's always at the top of my list (next would be folate, iron, and sodium -- from drinking all of the potassium).

Oh, I forgot to mention. I also get extreme & unusual tiredness. But not the kind where you need to take a nap. This is like you are going to pass out -- and I think I have actually passed out a couple of times. So this has been extremely scary.

I frequently refer to the low potassium symptom list on the Cleveland Clinic website (and usually by the time I take potassium, I have symptoms in the severe list):

https://my.clevelandclinic.org/heal...in-your-blood-hypokalemia#symptoms-and-causes

 

[debgrant]

I remember when grandma was on diuretics for many years and had to take a huge timed release potassium pill. Tended to give her a nasty bellyache. They never said anything about mag or b12 deficiency.