Is your heart lacking a key nutrient? Dr. Ruscio welcomes back Jeffrey Moss, DDS, CNS, DACBN, founder of Moss Nutrition to discuss why potassium is so important and strategies to ensure you have adequate levels to support optimal health and wellness.
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Dr. R’s Fast Facts
- Potassium is very important for muscle and especially heart function.
- Leafy green vegetables
- White potatoes
- Sweet potatoes
- Signs of imbalanced potassium are general fatigue, muscular fatigue, muscle aches and pains.
- Low serum potassium is a risk for sudden cardiac death.
- Causes of low potassium stress, caffeine and high insulin/carbohydrate intake.
- Lab testing:
- Low = serum potassium below 4.5 mEq/L.
- 3.5-5.5 is normal range. Optimal range is 4.5-5.
- Blood testing usually tells you something is interfering with potassium and not necessarily that there is a need for supplementation.
- Preferred Supplementation: Potassium citrate or Potassium bicarbonate. Potassium chloride may not be best. Potassium is best given with magnesium.
Intro to potassium…..7:31
Symptoms of low potassium…..16:07
Cardiovascular implications of low potassium…..17:13
Lifestyle factors that affect potassium…..21:50
Clinical approach with potassium…..26:47
Closing thoughts on potassium…..37:35
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The Key Nutrient Your Heart Is Lacking with Dr. Jeff Moss
Welcome to Dr. Ruscio Radio, discussing the cutting edge in health, nutrition, and functional medicine. To make sure you’re up to date on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor.
Now, let’s head to the show!
Dr. Michael Ruscio: Hey, guys, this is Dr. Ruscio, and before we go into our fast facts, I just wanted to let everyone know that I will be teaching a seminar in London that I’m really, really excited about. It’s a two-day event, January 16 and 17, in London with Melissa Hartwig and myself.
Day one will be a split between Melissa talking about the Whole30 Program and all the great stuff that entails implementing the Whole30 and how to navigate that and just the great program that she’s put together there.
The second half of day one I will come in with what are some first steps someone should go through if they’ve been on a healthy diet like Whole30 and they’re not able to respond fully. This is pretty much what I do in the clinic all day, so I’ll just be expanding upon that.
What I’m really excited about is the second day, which will be an even deeper expansion on all these issues in gut and with a little bit of expansion on thyroid. The second day is geared toward a more educated layperson or a patient who’s suffering with nonresponsive problems or, of course, a healthcare professional. We will be offering continuing education credits for that day, and some of the gut stuff should be really, really helpful. Of course, you’ve heard me talk about all sorts of gut “stuff,” to put it loosely, from testing to microbiota to treatments, so I’ll help outline what some of the most common causes of digestive problems are, what testing you can use to figure that out, and that is oftentimes much easier said than done, so knowing how to perform the right tests to get the right diagnosis and also doing it in a cost-effective manner is really what we’re going to be going after.
Another thing that I’m really excited about is a review of all gut and microbiotal interventions. If we’re talking about probiotics or prebiotics or fiber or FMT or fasting or an elemental diet, what kind of effect do those interventions have for things like IBS, IBD, weight loss, thyroid problems, celiac? I will break all of this down so that you will know for what condition you have—or for what conditions your patients have—what treatments are the most viable and the most validated. Then, of course, we’ll wrap that all together with an algorithm, if you will, or putting-it-all-together kind of action steps as to how to sequence this stuff. That will be about 60 percent of day two.
Then the tail section of day two will be on thyroid, something I haven’t talked a lot about lately on the podcast because we’ve been so inundated with gut stuff, but there’s certainly some very important thyroid stuff, as I’m sure many of you have heard me talk about awhile back regarding thyroid diagnosis, types of thyroid problems, and a simplified model of thyroid disorders. We’ll cover subclinical hypothyroidism, which is a pretty important issue. We’ll talk about iodine and give you some simple, straightforward treatments to navigate through thyroid.
I’m really, really excited about this. If you’re in the UK, I hope you can make it over to London to check it out. If you see the transcript, you will see the link for this, and if you’re just listening, if you google “Re-FIND Health” and then “Michael Ruscio,” you’ll see my name come up. Hopefully this will be something that some of you can attend, and I think it’ll be very well worth it.
OK, now we’ll jump into the fast facts. Thanks.
DrMR: Hey, everyone, this is Dr. Ruscio. I just wanted to give you the fast facts for today’s episode, which was very interesting, with Dr. Jeffrey Moss talking about the importance of potassium for your heart.
Potassium is very important for muscular function and especially for heart function.
Signs of imbalanced potassium are general fatigue, muscular fatigue, muscle aches and pains.
Low serum potassium, or low potassium on a blood test, is a risk for sudden cardiac death. This is a fairly big deal, and Dr. Moss does a good job elaborating on the importance of this and how underrecognized this is.
Causes of low potassium are stress, caffeine, and high insulin levels.
Lab testing for potassium: When people consistently have a blood test where potassium is below 4.5, this may increase their risk of sudden cardiac death. The range is 3.5 to 5.5. But importantly, when potassium is low on blood testing, this usually tells you something is interfering with potassium and not necessarily that there is a need for potassium supplementation, but rather a need to look into metabolic imbalances, too much stress, too much caffeine, too much carbohydrate, an inflammatory problem, what have you.
Supplementation with potassium should be done as potassium citrate or potassium bicarbonate and not as potassium chloride. This may not be the best form to give.
Usually when giving potassium, giving potassium along with magnesium is a good idea, but remember, just seeing low potassium does not mean that we should take or we should give potassium, and we’ll elaborate a bit more in the episode.
OK, hope you guys enjoy it. Thanks.
DrMR: Hey, folks. Welcome to Dr. Ruscio Radio. This is Michael Ruscio. I’m here with my good friend, Dr. Jeffrey Moss. Hey, Jeff, how are you doing?
Dr. Jeffrey Moss: I’m doing well. Thanks for having me.
DrMR: It’s a pleasure to have you back. I know people really liked the last episode that we recorded talking about muscle mass and the ideal protein intake for muscle mass and general health, and I have been catching wind of a few of the articles. I know you’ve been writing a lot on potassium, and I’ve skimmed a few of your articles. I picked out a few really interesting tidbits but didn’t have a chance to really dig into the articles fully, so I shot you an email and said, hey, would you mind coming on to kind of elaborate on all this potassium research you’re going through and the writing about potassium and the potential health implications regarding potassium, because it does seem like there are some very important, but under-reported or under-acknowledged impacts that potassium has, so that’s what I thought we could launch into today.
Intro to Potassium
DrMR: I guess to get us started, Jeff, can you give us just a basic intro to potassium, some important functions that it has in the body, and then maybe some common food sources?
DrJM: Sure. Well, people like to group nutrients or minerals such as potassium and magnesium as just minerals, but really they aren’t. They aren’t microminerals. Actually they’re macrominerals, particularly potassium, and it’s in the category of electrolytes. Along with water, it basically is involved in just about every function of the body you can think of.
I heard a very interesting definition of life from someone you know and we all know and respect, Dr. Jeffrey Bland. What he said, how do we define the life as opposed to the inanimate object? The inanimate object, the rock, is equilibrium. What does that mean, equilibrium? If you have a membrane, a cell membrane, from your basic chemistry classes, there are equal amounts on both sides of the membrane. It’s equal. That’s equilibrium. Life is basically keeping more stuff on one side than the other side, primarily meaning water and electrolytes such as potassium, magnesium, calcium, sodium, and chloride. So the ability to keep more of it on one side than the other, whether it be a piece of filter paper in your chemistry class or a cell membrane, is really at the heart of all life functions, of living, and so it really is involved in everything.
What makes it interesting and why I became interested in the subject of potassium, even though all these electrolytes and, of course, we have this kind of good guy/bad guy scenario. Sodium bad, magnesium good.
DrJM: We’ve gotten into that good-versus-bad scenario, which is really a complete misrepresentation. The key issue is balance. It’s all about balance, what’s on one side of the membrane versus on the other side of the membrane at any particular time and the balance between all of them. The key matter is balance, and for whatever reason, the ones that get all the attention these days—sodium, of course, that gets all the attention along with chloride. That’s salt, table salt. Magnesium we’ve all heard about. We all talk about the need for magnesium, but really the other side of the magnesium coin, if you will—they function together—is potassium, and I found it really wasn’t getting the attention it deserved. All too often, I heard more about cautions about potassium rather than recommendations, a great deal of misunderstanding, even though the RDI for potassium is 4.5 grams a day. That’s a lot of potassium.
DrMR: But, Jeff, isn’t part of that reason why we see—I believe there’s a restriction on the dose of a potassium pill. Isn’t it supposed to be under 99 mg?
DrJM: Yes, what they call the old wives’ tale. I’ll tell you where it all came from. We checked this out, and we had heard it for years—can’t have more than 99 mg. This basically started out with research on potassium that was done in a hospital-based setting, and they found out if you gave too much potassium supplementally, you could stop somebody’s heart because the heart is a muscle and all muscles basically function based on this fluid and electrolyte balance. So if you get an imbalance by giving too much, you could stop the heart.
And of course, this kind of caught on. Particularly the anti-nutrition brigade love publicizing stuff like that. What they didn’t say, of course, is all the research was based on intravenous administration. Using potassium in intravenous, of course, is regulated as a drug. When you give it intravenously, it’s regulated as a drug, and the FDA indeed did impose limitations on how potassium can be administered intravenously as a drug. They never—and we did check this out. I have an FDA attorney, and we checked this out several years ago when we were first looking into making potassium products at Moss Nutrition. I said, what’s the validity? He wasn’t even sure, but he calls up the FDA, and he finds out there are no restrictions of this type on oral administration of potassium. It doesn’t exist. It’s an old wives’ tale. It’s basically something that has been perpetuated. You know the old telephone game? Enough people say it—
DrJM: There is no restriction on oral.
DrJM: Now, he did say, of course, there are liability issues if you give too much and you harm somebody, but that can happen with vitamin C or anything else. That’s a separate issue. That’s an issue of overdosing, poor administration, unintelligent administration, but there’s no law, per se, that says giving minute amounts—and 99 mg is minute—the FDA places no restrictions on that when given orally.
DrMR: Gotcha. That’s good to know. I didn’t know that background. You want to continue with some of the important functions for the body, in terms of potassium?
DrJM: Sure. Probably the most important functions relate, again, to muscle, what I talked about before, and more specifically, from a clinical standpoint, the heart because the heart is a muscle. But muscle function, in general, basically is a conductivity issue. Basically it’s electricity, what makes our muscles move. There are electrical signals that come from the nervous system, and in turn, this signal gets into muscle and the muscle will contract, and the ability to contract is based on this specific ratio or relationship between water and all the electrolytes. I mentioned five of them, major electrolytes—sodium, chloride, calcium—yes, calcium is an electrolyte; it’s more than just a bone nutrient—and potassium and magnesium, and you need this proper balance. So I’m looking at potassium as being important from a relative standpoint.
There’s a very interesting paper that was written in the Journal of the American Medical Association several years ago, which is just common sense ain’t too common, and they talked about the nature of nutrients and why they are beneficial when you give them supplementally. It’s not magic. They’re not drugs. They basically work best when you’re deficient and you replete a deficiency. It’s common sense. Why do we talk about potassium so much? Why is it important? Because so many people aren’t getting enough! Why do we talk about sodium as being bad? It’s not inherently bad. People are getting too much!
DrJM: That’s the real reason we’re focusing on potassium, is because so many people are just not getting enough, and why aren’t they getting enough? Unlike sodium, which is added to many, if not most, processed foods, and sodium is liberally used in restaurants because of taste issues, potassium is on the other side of the coin. It’s not added really to the processed foods at all, and it’s only really found in green leafy vegetables, for the most part. It’s not found in any appreciable quantities in animal protein, and again, in processed food, you tend to see it accentuates the sodium, but the potassium and magnesium are largely depleted. So what we have is a society over the last few decades that has been systematically depleted of potassium both because of enhanced ingestion of processed food and decreased ingestion of green leafy vegetables.
Symptoms of Low Potassium
DrMR: Gotcha. Now, that manifests as problems with muscle function. Are there some common signs of low potassium? I believe cramping and muscle twitching may be some, but if someone’s listening to this and they’re trying to figure out, do I have some common symptoms, what would you advise there?
DrJM: Fatigue. Difficulty not only with general fatigue, but I’m climbing the stairs and I get so tired, or I take a walk and I’m so tired, and I start getting achy. This issue of potassium specifically and the electrolytes generally is a major issue. The muscles tend to become… we’ve all heard about this acid-alkaline balance thing, and they become too acid. Potassium is a primary alkaline mineral. When you become too acidotic, you start producing acids. Lactic acid, we’ve heard of that. And you start getting achy, sometimes crampy, and you get fatigued.
DrMR: Gotcha. So muscle aches, pains, cramps, fatigue.
Cardiovascular Implications of Low Potassium
DrMR: I know you’ve written quite a bit about the cardiovascular implications of this, so do you want to expand a little bit on how this can manifest as negative cardiovascular complications?
DrJM: Sure. Most of the time, what we talk about are general quality-of-life issues—like I said, I’m tired, I don’t feel good, I’m achy. Rarely in the field of clinical nutrition do we talk about nutrients in terms of an immediate life-or-death scenario. In 2002, my father, who had a lot of heart problems, he had bypass operations, and he was on numerous pharmaceuticals and was far from living a healthy lifestyle, but he was told by everybody that he had been stabilized… until one day he wasn’t. Out of the blue, he goes into tachycardia, literally out of the blue, and is dead within minutes. And I was very curious because he had sent me his blood chemistries from a few months before, and I didn’t really understand at that time, but I noticed some curious imbalances in the electrolytes, not just potassium, but sodium. I didn’t know what to make of it. He wasn’t symptomatic in any way, a little tired, but I didn’t know what to make of it, and I was just very curious.
We see this so often, that people have a heart attack. We see it in young people, athletes; they just drop dead. We see it in older people, always without warning. We have no idea what happened, and I’m always curious. Certainly many of these people were living a less-than-optimal lifestyle, but the question occurred to me, but they’ve been doing that for years. Why now? Why did they die now? Must be that something happened now that wasn’t happening before. Why not yesterday? Why not tomorrow? Why not an hour after they died? Why not an hour before? What happened at that moment? And I just thought, could it have something to do with electrolytes and specifically potassium?
With that, I really started looking at it and reading about the physiology of potassium. Number one, I discovered that in particularly the heart, balance is critical in terms of the heart beating optimally, the rhythmic beating of both the ventricles in particular, but also the atria. This critical balance of electrolytes, and specifically potassium is most important. The balance between how much is in the cell and how much is outside the cell circulating in the bloodstream. It’s absolutely critical.
And as I started reading more and more, I noticed this balance is very specific. If it changes just slightly, you can go into a very significant arrhythmia situation. I also noticed that there are certain things, lifestyle issues, that can change the balance dramatically, literally within seconds, in terms of how much is inside the muscle cell versus how much is outside the muscle cell in the circulation.
The literature, I found there are more and more papers on this. In fact, there are several papers on what they call hypokalemia, low serum potassium, and sudden cardiac death. Several papers have been written on it, and really for me, I looked at this, I saw research not only on the elderly and the middle-aged, where we typically see it, but what really interested me beyond my father’s demise is when we read about these young athletes. They’re running a marathon or they’re swimming in a swimming meet or whatever. We’ve seen these reports. They’re on the basketball court, and they literally just drop dead of a heart attack. Of course, they open them up and they say they had a genetic defect. Well, my question is the same thing I asked before. All right, they have a genetic defect. They’ve had that since birth. Why now?
DrJM: Something different had to happen now as opposed to yesterday, the hour before, the hour after—something changed. Could that something be a catastrophic change in potassium balance combined with the genetic defect? The straw that broke the camel’s back?
Lifestyle Factors That Affect Potassium
DrMR: You said there were some lifestyle factors that can really potentiate this potassium imbalance. What are some of those factors?
DrJM: Primarily it has to do with the hormone insulin. Now, we all know about insulin. It’s designed to get glucose into cells, and when insulin doesn’t work, insulin resistance, it’s diabetes. Well, insulin is the primary anabolic hormone. What does “anabolic” mean? It means “get stuff into cells.” That’s anabolic. Get stuff into cells. Insulin does more than just put glucose into cells. It puts all kinds of stuff. It puts protein, it puts fat, it puts water and key electrolytes such as potassium and magnesium. And there are several lifestyle issues where if you get a sudden increase in insulin, you’ll get a catastrophic increase in the potassium inside the cell, you get a catastrophic decrease in the circulation, and literally in certain susceptible individuals, you can put them into tachycardia, arrhythmia, and sometimes a fatal arrhythmia. What can do it? Probably the biggest single one is refined carbohydrates or a high-carbohydrate meal, particularly when you haven’t eaten for a while. This typical scenario—you skip meals and then you binge on carbs.
DrJM: You see that all the time. You can get what they call hyperinsulinemia. You get an insulin spike, which immediately starts driving potassium into the cell. That alone will not cause a heart attack. You have to have other issues going on. I’m talking about people, many times the older person, they’ve eaten poorly, maybe they’re on medications—lots of things going on, and this driving the potassium into the cell is the straw that breaks the camel’s back.
It’s also these young athletes. It’s really hot out, they’ve been exercising, they don’t eat right, they’ve been carb loading—again, the straw that breaks the camel’s back is what’s been suggested, this catastrophic alteration in potassium.
What I’m describing here has been known for years as the “refeeding syndrome.” The refeeding syndrome, basically what it is, is they started noticing this during World War II, but where they really started noticing it was in the hospitals, where they get a burn patient, for example. They’ve been unconscious, say, for 10 hours. They haven’t eaten. And they put them on a standard intravenous feed with potassium, and all of a sudden, it just goes crazy. All of a sudden, they get a massive heart attack and die, and they wonder, what happened here?! We just did the standard feed and they died! Had a heart attack! Well, they started looking into it, and they noticed these spikes in insulin.
Really where this was first discovered, it was kind of interesting, during World War II. The Allies went into the concentration camps, and they saw these starving people. They said, well, let’s feed them! So what did they have? They had their K-rations, and they started giving them candy bars. All of a sudden, these poor prisoners started dropping dead!
DrJM: What’s going on here?! That’s where really we first started seeing these scenario of the refeeding syndrome. Of course, this is an extreme situation. Can we see it to a modified extent when just the everyday, ordinary person ingests too many carbs, they haven’t eaten for a while, and they start getting this imbalance of electrolytes? What would we tend to notice, the average individual? We used to call this reactive hypoglycemia. Oh, I don’t feel well, and I’m kind of tired, and I want to go to sleep. Maybe I get some heart palpitations. That’s a very mild form of this refeeding syndrome that comes when you get these insulin spikes, which starts driving the potassium into the cell and reducing the potassium outside the cell in general circulation.
DrMR: Gotcha. That’s remarkable that a lot of people had to die, unfortunately, for them to discover this.
DrJM: Yeah, and it’s really, even now, underappreciated. Anything else that will increase or drive up insulin can potentially have the same effect. What can drive up insulin? High levels of stress, a stressful event, stimulating cortisol. And the other big one that I think is grossly underappreciated—caffeine.
DrMR: Hmm. So stress, caffeine—definitely two things that most Westerners are going to have their fair share of—and then blood sugar regulation, another thing that many Westerners are not going to be doing a great job with.
Clinical Approach With Potassium
DrMR: I think a lot of people on the call probably are trying to mind their blood sugar regulation, their stress levels, and their caffeine consumption, but what else could we do clinically to try to turn this around? I know you mentioned in some of your writing a certain potassium lab value.
DrMR: Are their ratios that you look for? Is there a certain supplemental ratio you try to supplement these things back with, or are you using just straight potassium? What does that clinical side of this look like?
DrJM: First of all, I want to emphasize again that this is not just a general problem. You can go along, and the potassium is fine, but then let’s say you’re on a plane trip and your eating schedule is off and you’re not in that good a health to begin with, and then after not eating 10 hours, you decide to have a donut and a cup of coffee.
DrJM: The change can be almost instantaneous, within seconds. So with that in mind, let’s talk about blood chemistry. Now, the old thinking on serum potassium was you’re OK if you’re between 3.5 and 5.5. That’s the standard. Anybody who looks at the routine chemistry, they’ll see that the normal is 3.5 to 5.5. That was basically determined based on really gross pathology, life-and-death scenarios, not necessarily quality of life. The literature on quality of life—and particularly the relationship to heart disease—it should be right between 4.5 and 5. They start seeing increased risk of heart dysfunction even at 4.4 or 4.3. These electrolytes, the balance is so critical. It doesn’t take much to start having problems. So I would say to you, your routine chemistry, take a look at it. And even though it’s above 3.5 and most everybody would say, oh, you’re fine, if you get to 4.0, there’s an issue. I’m not saying you’re going to die or get a heart attack, but it’s a concern. You get in the high 3’s, definitely a concern. So 4.5 to 5.0.
Now, the other way that is kind of a gross measurement for potassium need is you can take a look at first morning urine pH. It’s a very simple measurement. Ideally what we like to see is the first morning urine pH at right around at least 6.4, a range of 6.4 to 7.0, in that range there. If you’re below 6.4, that would suggest that you’re low in these alkaline minerals, specifically potassium and magnesium, and what we’ll do is we’ll have people supplement, generally taking a capsule of a combination product, potassium-magnesium, or just a potassium product. Everybody’s different on that. Take a capsule before bedtime and then check it the next day and see if it came up to 6.4. Then we have people just kind of gradually increase dosage until they get that range of somewhere between 6.4 and 7.0.
Those are the two ways that are very easy, very convenient, very inexpensive, really, to monitor need, and supplementation can be used. The forms of supplements that are most well researched in the literature are potassium bicarbonate and potassium citrate. Now, the most common form of potassium supplementation that you’ll find in the retail marketplace is potassium chloride. Why? It’s dirt cheap. It’s what they tend to use. They’ve used it in the hospitals for years. However, when it comes to this critical acid-alkaline imbalance, the chloride part of it is an acid! So you don’t want to give potassium along with chloride. The preferred form in terms of getting this optimal electrolyte balance, potassium balance, is going to be the potassium bicarbonate or potassium citrate, and of course, what you get in your diet—green leafy vegetables, bananas, that type of thing.
DrMR: Gotcha. You know, it’s interesting the stress piece you mentioned a moment ago and how that has an impact. For a little while there, I was monitoring my morning urinary pH, and I would definitely notice on mornings where the day before was a high-stress day, usually a higher-stress day is accompanied by a higher caffeine consumption on my end also, I would definitely notice that my pH would be quite a bit more acidic. It’s interesting. I definitely observed that those factors had an impact, at least on my urinary pH.
DrMR: Something I’m wondering, Jeff, is, have there been clinical trials where they’ve taken people at high risk for cardiac death and supplemented them and that’s shown any impact? I know you’ve reported that—and, please, correct me if I’m wrong on this—but it seems like in the literature we observe that those that have a lower potassium, lower than 4.5, their risk of sudden cardiac death goes up.
DrMR: So the question I always ask on the other side of that is, do we have trials supplementing with potassium, showing that the risk of sudden cardiac death goes down?
DrJM: Not a lot of intervention trials. Most of it’s what they call epidemiologic, these population studies. They have found some epidemiological studies looking at diets higher in potassium. There’s not a lot on specific interventions giving this potassium supplement and specifically having an impact on heart disease. The reason is heart disease is a complex issue, and it’s more than just electrolytes. Just giving potassium alone to someone at risk for heart disease, would you see a noticeable benefit? Probably not, because there’s a whole host of other issues that come into play—inflammation, homocysteine—and so a single intervention with just potassium you probably won’t see too much. The exceptions, of course, are going to be in crisis situations in a hospital, where they’re having an acute heart attack.
There has been some research not necessarily on potassium, but the other side of the coin—and you can bring potassium into this kind of indirectly—experimenting with magnesium sulfate intravenously. As you might expect, given the complexity of the problem, the feedback or the research has been uneven. Giving magnesium in this scenario and having an impact, it does bring potassium into play because the literature is very clear that potassium cannot do its job alone in the cell without magnesium, and magnesium cannot do its job alone without potassium. The ability to travel to the various organelles, get into the cell membrane—they must work together. We really need to reframe our thinking, particularly on magnesium. We all talk about the need for magnesium supplementation. If you have a need for magnesium supplementation for whatever reason, whatever indicator you have seen—I need magnesium, my patient needs magnesium—they need potassium. You cannot have one without the other. The literature is clear. So just wherever you see a need for magnesium and wherever you see magnesium having an impact on whatever function you’re talking about, whether heart function or anything else, potassium must go along with it.
DrMR: Gotcha. That’s a great point. Jeff, have you noticed with tracking any of the patients that you work with in improving their stress, their diet, their lifestyle, are you seeing their potassium levels improve on labwork from that, or have you not had anyone that you’ve isolated for and not given supplemental magnesium and potassium?
DrJM: Sure, you do see it. They will start going up. Now, the people I see generally, I have a small practice, and we’re not dealing with crisis care.
DrJM: Mainly just people who are tired, have chronic issues, chronic aches and pains, that type of thing. But certainly, yeah, when I tend to see them, they’ll be in the high 3’s, low 4’s, and they start improving symptomatically with supplementation, which may include potassium and may not. There’s a whole variety of factors that are going to impact serum potassium, so I want to emphasize when you see low serum potassium, it’s not just a matter of giving potassium.
DrJM: There’s a metabolic imbalance that relates to inflammation and insulin, that has to do with how much carbohydrate you eat and how much caffeine you drink. You could have just as big of an impact on your serum potassium in terms of raising low levels by decreasing coffee intake as giving potassium supplementation.
DrMR: That’s an excellent point.
DrJM: Low potassium does not mean just give potassium. It means optimize lifestyle, which may include giving potassium.
DrMR: That’s an excellent point. I’m so happy that you said that. I think it’s worth reiterating that we want to look at the potassium on labwork and track that, but don’t just blindly think that giving potassium and increasing that number is going to increase the patient’s overall health or the person’s overall health because we’re really trying to treat the person, not just treat the lab value. Just like you had mentioned a moment ago, we want to work on stress, blood sugar regulation, caffeine consumption, and keep an eye on the potassium and maybe give some supplemental potassium and magnesium if it seems indicated, but definitely make sure we have that foundation of our lifestyle and just general internal health that we’re addressing as a way to drive this.
DrJM: Exactly. I want to say one last thing about the serum potassium. Most people think when they see a serum level of a nutrient that means the diet is too low. That is not true with potassium. It may mean a low diet, but most often what it means is there is an imbalance. When you see too little in the serum on your blood test, it usually means there’s too much inside the cell. It tells you imbalance. It rarely tells you deficiency. It can, and you can easily pick that up just looking at somebody’s diet, but more often than not, it tells about an imbalance. There’s too much in the cell, and that can relate to a whole variety of lifestyle issues other than diet.
DrMR: Gotcha. That’s a great point.
Closing Thoughts on Potassium
DrMR: All right. Well, are there any other closing notes? I think you just gave your closing note, but any other thoughts or pieces you want to make people aware of before we wrap things up?
DrJM: Sure. Can you open up an obituary section any day in the newspaper and not read about somebody, usually a middle-aged male, just drop dead of a heart attack? Leaving family, coworkers—it’s just a tragedy—and everybody says, we had no idea. There was no way to predict. I’m not saying I have a crystal ball here, but what I am saying is that when we see people living certain lifestyles and reaching a certain age, take a really close look at the potassium. If you can, get that blood test. And if they’re below 4.5, do whatever you can to get it above 4.5. I’m not saying they’re going to die of a heart attack. I don’t know. But the statistics are such, there are enough people that are dropping dead of these heart attacks without warning. Particularly tragic are the young people. I really do feel, based on the research that I read, and if anybody would like to see the newsletter series with all the research, please email me. I’ll be glad to send it to you. I really feel it’s important to get the word out that I think this is a really major unrecognized risk factor.
DrMR: Right. Well, that’s one of the main reasons why I wanted to have you on the show, was just to bring this into the forefront because as you also had mentioned, magnesium gets a lot of attention, potentially in some circles vilifying sodium gets a lot of attention, but this potassium piece doesn’t seem to get that. And especially when we tie back to the fact that this low potassium may be a risk factor for cardiovascular episodes, that may be just another motivator to get people to improve their diet, improve their lifestyle, and then also potentially consider supplementation. But I think the biggest thing here is just trying to find out why the potassium is low to begin with and just recognizing that if we see that, we have to act, not necessarily keep caffeine overconsumption and overindulgence in sweets the same and try to just add in a potassium supplement, but look deeper into why this crucial electrolyte imbalance is starting to occur and realizing that that may have some potentially fairly devastating cardiovascular implications if not addressed.
DrMR: Yeah, this has been great, Jeff. I love your perspective and the way you, of course, support everything with the literature on this. Hopefully people will get a lot out of this call. I’m sure we’ll have you back on again at some point in the future, Jeff, and thank you so much again for taking your time out to speak with us.
DrJM: Thanks for having me.
DrMR: All right. Thanks, Jeff.
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