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WARNING - LOW POTASSIUM IS DANGEROUS

ahmo

Senior Member
Messages
4,805
Location
Northcoast NSW, Australia
@Nikki7 I needed high doses of K+ for a couple years while implementing Freddd's Protocol. I generally took mine in footbaths, to spare my gut, except when I needed additional doses during the night. I proceeded through my start-up by following symptoms and self-testing. After a high of 30mg folate/B12, I'm now needing only 2mg each. A number of us have experienced what seems to be a saturation point, after which we can decrease the supps.
 

Mary

Moderator Resource
Messages
17,286
Location
Southern California
Dear soccer_dude. Nobody on PR actually knows anything about this as far as I can see. From what people write, including Freddd, it seems they make it up as they go along. If low potassium after increasing methylation was truly dangerous then members of PR would be lying about dead like wasps in a glass of beer. YOur body holds vast stores of potassium. Shifts occur over 24-48 hrs if metabolism changes. There seems to be no reason why stimulating methylation would increase potassium requirements over a period of more than a week at the very most. You only need more potassium if you pee it out more.

I think it would be wise to assume that nobody here has a clue. And if it is a matter of medical safety we are not allowed to give you advice anyway.

But we are lying around like dead wasps, thousands bedridden, many thousands more living ghost lives, barely able to function. You might take a look at this: http://www.mybwmc.org/library/41/033700
It states, in pertinent part: "treatment of vitamin B12 megaloblastic anemia may result in severe hypokalemia, sometimes fatal, due to intracellular potassium shift upon anemia resolution."

My guess is that we are not as deficient in B12 and folate as people who are starving or severely anorexic, which is why we are not dying from hypokalemia, but we are sick enough. And I'm not saying everyone who is bedridden with CFS/ME has hypokalemia, but that hypokalemia is a serious issue for very many of us.

No one's making anything up here. If you do more reading on the treatment of megaloblastic anemia, you'll find a lot information about the connection between hypokalemia and treating B12 and folate deficiencies.

Here's my experience: I started Freddd's B12 and folate protocol 5-1/2 years ago. My energy picked up markedly within 2 days, it was great. and then about 2 days later I hit a wall, felt like I had been hit by a truck, energy gone etc. If I had not read about the potential for hypokalemia, I would have stopped the protocol. Fortunately, I'd read several of Freddd's posts and read a lot more outside information on my own about potassium, and titrated up gradually over a couple of days to 1000 mg. in divided doses, and within a couple of days that horrible fatigue went away. And I had had that awful fatigue before starting Freddd's protocol, only I never knew what it was before. My potassium levels were always low-normal on blood work.

I continue to take 1000 mg. potassium gluconate in divided doses and a glass of low-sodium V8 and I manage to keep low potassium symptoms in abeyance.

Richvank did a very good post about the problems CFS/Me patients have with potassium and if I can find it, I'll post a link.
 

Mary

Moderator Resource
Messages
17,286
Location
Southern California
@Jonathan Edwards: Here is Richvank on potassium and the special needs of people with CFS/ME;
http://forums.phoenixrising.me/inde...ded-in-methylation-treatmt.18670/#post-291422

Yes, I agree that 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
 

Freddd

Senior Member
Messages
5,184
Location
Salt Lake City
@Jonathan Edwards: Here is Richvank on potassium and the special needs of people with CFS/ME;
http://forums.phoenixrising.me/inde...ded-in-methylation-treatmt.18670/#post-291422

Hi Mary,

Thank you so much. I had never seen this before though I sure tried to read everything he wrote. I came across some quotes from him out on the web and backtracked him to PR. He is the reason I ended up here.

I have never managed to eat enough food potassium. There was one winter I worked as a pro ski patrolman and at 40 below and skiing all day I ate over 5000 calories daily and a pound and a half of meat, at that was the only time I didn't have all those spasms. Food potassium according to studies reaches serum peak about 14 hours after consumption. For me it just isn't fast enough to stop a problem once it starts. The first time I got the spasms and had the potassium on hand it was in the kitchen with all my other vitamins. It took me 45 minutes to painfully make my way to the kitchen. Now I keep them and a bottle of water by my bed.

I have suspected some sort of polymorphism or something to cause my potassium problems all the way back in childhood as well as folate problems. I don't process vegetable folates well nor folinic acid or folic acid. They actually block l-methylfolate from working. Rich and I were doing some mutual data exchange and interpretation and I was about to invite him to join me in a project when he died suddenly.

We had complementary experiences, ideas and interactions and it was very stimulating for both of us. He knew the biochemistry and could find the supporting research and I was the data geek. Data mining the internet is critical to solving this and many problems.
 
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Messages
87
@Nikki7 I needed high doses of K+ for a couple years while implementing Freddd's Protocol. I generally took mine in footbaths, to spare my gut, except when I needed additional doses during the night. I proceeded through my start-up by following symptoms and self-testing. After a high of 30mg folate/B12, I'm now needing only 2mg each. A number of us have experienced what seems to be a saturation point, after which we can decrease the supps.
Can you recommend a brand for the foot baths? Thx so much!
 
Messages
1
I am a heart patient (diastolic heart failure) with CFS and am confused by the information about potassium. I thought that supplementing with it was essential and that depletion was dangerous. And now...potassium deficiency protects the heart??
 

Jonathan Edwards

"Gibberish"
Messages
5,256
I am a heart patient (diastolic heart failure) with CFS and am confused by the information about potassium. I thought that supplementing with it was essential and that depletion was dangerous. And now...potassium deficiency protects the heart??

Dear Juanita,
I don't think any of us know anything particular about potassium and ME here - nor probably any of the people quoted. People are just recounting their experiences. If you have a heart problem and want sound advice you should get it from a doctor not from here.
 

Freddd

Senior Member
Messages
5,184
Location
Salt Lake City
I am a heart patient (diastolic heart failure) with CFS and am confused by the information about potassium. I thought that supplementing with it was essential and that depletion was dangerous. And now...potassium deficiency protects the heart??

@juanita,

I hope the information on here is not contradictory about potassium. LOW POTASSIUM IS DANGEROUS. Enough potassium is essential. For instance I have lots of arrhythmias when potassium goes too low in me and my blood pressure goes up. High potassium can also be dangerous. My potassium is measured at every office visit. It's a struggle to keep it high enough. Various medications can affect potassium levels. I have fewer problems when in the upper half of the range for serum potassium. My first low potassium symptom is paralyzed gastro problems and I have a prescription for that when needed to get my system going again. I try to take enough potassium to keep that from happening but it isn't easy. If you want to quote something confusing on potassium with source, we can discuss it. I don't know where that statement you made came from. Good luck
 
Messages
2
@Freddd what is your prescription for paralyzed gastro problems? I also suffer from severe bloating and burping one year after starting the quartet. This was evident when I increased the methylfolate to more than 15mg per day.
 

Freddd

Senior Member
Messages
5,184
Location
Salt Lake City
@Freddd what is your prescription for paralyzed gastro problems? I also suffer from severe bloating and burping one year after starting the quartet. This was evident when I increased the methylfolate to more than 15mg per day.

@chrysos,

I am prescribed Metoclopromide (Reglan), 10mg per dose. This medication has a black box warning. This is used in the USA. There is another drug used in some countries that is not used in the USA. I use mostly a 5 mg dose which works most of the time. One of the side effects it can cause which can be permanent is Tardive dyskinesia. It has a lot of other potential side effects. It does work very well for me. I try to not take it more than 3 occasions a week. I need to take 2600mg of potassium a day currently in at least 4 doses, with 1000mg with each full meal, and 300mg with a full glass of water or snack. It can give me relief starting in 15-20 minutes. If I get enough potassium I can avoid using it. Sometimes the problem can be caused by other medications, such as opioids. I can see a 3/16ths inch band on my big toe nails from the period when my methylation was down because of copper deficiency. When I got methylation started and ATP going with MeCbl, l-methylfolate and such I have had a large increase in the thickness of my nails. This improvement with thickness comes along with healing of various symptoms. This time my varicose veins and spider veins are all improving, my hair is getting it's color back in patches for the inch or two out from the roots. Good luck. I find that I have potassium problems with serum potassium as high as 4.3. It can drop like a rock. My doctor understands this. My goal is to get my potassium up to and maintained at 4.5. I haven't succeeded in years of trying. I get tested for potassium with every blood test I get. I have been able to keep it high enough for a couple of weeks, but then something always happens. For instance I have skipped a meal occasionally and that missing 1000mg of potassium gives me a problem for at least a week typically.
 
Messages
2
Thank you @Freddd.
The fact is that I tried high doses of potassium but not more than 2000mg and not in a strict systematic way i.e. timing and dosing in meals. Now I take 1.5 to 2 grams per day, most of it after 18:00. The symptom of potassium deficiency I get is not cramps but increased heartbeats i.e.90. It could be that despite that there is no indication of cramps or increased heartbeats other issues like low intestinal motility and dyspepsia ensue. I have tried to use occasionally high doses, to easily resolve problems of increased heartbeats in 30min, but according to what you say issues like intestinal motility need a more systematic way and significant time to resolve i.e. more than one week. Maybe this is the reason that I could not identify a connection between potassium and intestinal motility. I will follow your proposal for systematic and high doses of potassium and report back. Thanks again :)
 

Johnmac

Senior Member
Messages
756
Location
Cambodia
Thank you @Freddd.
The fact is that I tried high doses of potassium but not more than 2000mg and not in a strict systematic way i.e. timing and dosing in meals. Now I take 1.5 to 2 grams per day, most of it after 18:00. The symptom of potassium deficiency I get is not cramps but increased heartbeats i.e.90. It could be that despite that there is no indication of cramps or increased heartbeats other issues like low intestinal motility and dyspepsia ensue. I have tried to use occasionally high doses, to easily resolve problems of increased heartbeats in 30min, but according to what you say issues like intestinal motility need a more systematic way and significant time to resolve i.e. more than one week. Maybe this is the reason that I could not identify a connection between potassium and intestinal motility. I will follow your proposal for systematic and high doses of potassium and report back. Thanks again :)

If FODMAPs are the cause (some so far very slender science says this is the case for ~75% of IBS people), the low-FODMAP diet can be extremely effective. It took me from a highly disturbed gut to 2% of symptoms in a day.

I mention it because it's 'low-hanging fruit' - free, easy to try, & easy to discard if it doesn't work.
 
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CCC

Senior Member
Messages
452
Here's an anecdote that might interest some on this thread.

An ICU nurse we know happened to mention that blood potassium isn't particularly stable. They monitor K levels semi-continuously, and she's seen them vary between (say) 3.5 and 4.2 in the space of an hour and for no reason and with no consequence. That said, the variability in those patients might be why they monitor them closely, but I didn't think to ask.
 

Ninan

Senior Member
Messages
523
Could brachycardia be low potassium or low C? I've been getting too little of both, my heart is pounding but at 70 bpm instead of my normal 85 and I feel awful, extremely weak. Some muscle cramps too. My potassium was low before and I think I've been getting too little, just through cooked foods. Been taking 250+250 mgs today and no difference. Magnesium doesn't help either. I'm not on B12 now because of gut issues but I ate a lot of liver a few days ago. @Freddd ? @ahmo ?
 
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Ninan

Senior Member
Messages
523
When I was low K+, my heartbeat was very heavy, possibly slow. FWIW, a lot of liver could mean you got a big dose of copper. 500mg K+ isn't much. good luck.

That's how it feels. Scary. It's very heavy and slower than normal (for me). I'm taking K, not K+. Potassium citrate and malate. Getting chloride today. I took 1250 mgs yesterday and 500 so far today. No change in symptoms. Wondering if I should go to the IR but don't know if they will help. I probably have a lot of K in my blood since I've taken a lot, so what would they do?

Can I take K sublingually, @ahmo ?
 

Ninan

Senior Member
Messages
523
IR, doctor ranting about my illness not being real. I hate this... Anyway my K was 3,4 which is lower than before so I guess that's the problem. They won't help though so now I'll have to deal with a post hospital crash on top of K problems. Pulse was really high today.

Going to try transdermal and sublingual K, stop salt for a few days and then eat less salt. And more K. Hope it helps.
 

u&iraok

Senior Member
Messages
427
Location
U.S.
Low sodium if you just need potassium, original if you need a more balanced electrolyte. I think electrolyte needs change hugely on these treatments. I used to load sodium, now I load potassium and only need a smaller amount of sodium.

I also noticed that when I added more potassium my need for sodium seems to have gone down. Interesting. Something with the potassium/sodium balance?

For about a year before I started Fredd's protocol I suddenly developed a need for bananas. Had two every day. Still do. I went my entire adult life, minus a 2 1/2 month period, never eating bananas. Didn't like 'em.

I wonder if I was potassium deficient even before I started Fredd's protocol and that also had something to do with why I needed extra sodium?

I never gave potassium a single thought before. I'm sure that is true of a lot of people.