Monday, August 8, 2011

Potassium deficiency in low carbohydrate dieting: High protein and fat alternatives that do not involve supplementation

It is often pointed out, at least anecdotally, that potassium deficiency is common among low carbohydrate dieters. Potassium deficiency can lead to a number of unpleasant symptoms and health problems. This micronutrient is present in small quantities in meat and seafood; main sources are plant foods.

A while ago this has gotten me thinking and asking myself: what about isolated hunter-gatherers that seem to have thrived consuming mostly carnivorous diets with little potassium, such as various Native American tribes?

Another thought came to mind, which is that animal protein seems to be associated with increased bone mineralization, even when calcium intake is low. That seems to be due to animal protein being associated with increased absorption of calcium and other minerals that make up bone tissue.

Maybe animal protein intake is also associated with increased potassium absorption. If this is true, what could be the possible mechanism?

As it turns out, there is one possible and somewhat surprising connection, insulin seems to promote cell uptake of potassium. This is an argument made many years ago by Clausen and Kohn, and further discussed more recently by Benziane and Chibalin. See also this recent commentary by Clausen.

Protein is the only macronutrient that normally causes transient insulin elevation without any glucose response. And the insulin response to protein is nowhere near that associated with refined carbohydrate-rich foods. It is much lower, analogous to the response to natural carbohydrate-rich foods.

A very low carbohydrate diet with more animal protein, and less fat, would induce insulin responses after meals, possibly helping with the absorption of potassium, even if potassium intake were rather limited. Primarily carnivorous diets, like those of some traditional Native American groups, would fit the bill.

Also, a low carbohydrate diet with emphasis on fat, but that was not so low in carbohydrates from certain sources, would probably achieve the same effect. This latter sounds like Kwaśniewski’s Optimal Diet, where people are encouraged to eat a lot more fat than protein, but also a small amount of carbohydrates (e.g., 50-100 g/d) from things like potatoes.

Kwaśniewski’s suggestions may sound counterintuitive sometimes. But, as it turns out, potatoes are good sources of potassium. One potato may not be a lot, but that potato will also increase insulin levels, bringing potassium intake up at the cell level.

29 comments:

Gretchen said...
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Gretchen said...

Spinach and other LC veggies are loaded with potassium. Eating more of such greens would make more sense to me than eating potatoes to get insulin levels up.

Ed Terry said...

Eating a high-fat diet provides plenty of potassium. I average 4,100 mg of potassium and 2,200 mg sodium daily. Whole foods are naturally high in potassium and low in sodium. In fact, I add sea salt to my food because I ran into a problem with hyponatremia.

wjones3044 said...

I eat a largely meat diet (less than 10 g carbs daily...no fruits or vegetables). My potassium levels were in the normal range in a recent blood test. (I've been eating this way for quite some time.) Interestingly, my sodium levels were low. Go figure.

Kindke said...

Lets not forget avocado's, super high in potassium and has a carb level acceptable for a LC diet.

David Isaak said...

Ned, that's an ingenious train of thought.

I think the problems people have with potassium on low-carb diets usually come during the period where they are losing weight rapidly. (Dumping water weight takes electrolytes along with it, and many low-carb diets advise drastically upping water intake.)

I don't think many people maintaining their weight on a low-car diet have potassium problems, and your hypothesis explains one of the reasons.

Like Ed Terry, I, too, had problems with hyponatremia after fairly rapid weight loss. On a doctor's advice, I was also following a low-sodium diet. If you are exercising, losing weight, sucking down lots of water, and not supplementing with more salt than usual you may be in dangerous territory. (In my case, I was awakened from sleep by convulsions. Not a pleasant experience.)

One of the first symptoms is often cramping--which people usually assume is from low potassium rather than low sodium.

Ned Kock said...

Hi Gretchen. There is no doubt that spinach is a great source of potassium, comparable to white potato on a gram-adjusted basis.

Still, many people experience symptoms that seem to be related to potassium deficiency during the Atkins induction phase, where vegetables are not only allowed but strongly encouraged.

The so-called Atkins induction “flu”.

Why? Maybe it is a drop in circulating insulin, combined with existing insulin resistance that many people already have entering the Atkins diet.

Ned Kock said...

Hi Ed, wjones3044, and David. Given that animal protein may increase potassium absorption, mediated by insulin, LC with emphasis on animal protein would also require more sodium to be consumed to allow the sodium-potassium pump to work properly.

Indeed, many people seem to experience hyponatremia on LC as well. Theoretically, those are the ones who should not experience hypokalemia.

Ned Kock said...

This reminds me of the so often trumpeted “evils of salt”. Well, you may want to take a look at this article linking high salt intake with REDUCED heart disease risk:

http://ow.ly/5RL3O

Ned Kock said...

Avocados have an amount of potassium comparable to that of white potatoes, gram-for-gram. But not enough carbs to lead to any significant insulin response – Atkins induction “flu”.

Gretchen said...

Ned, whenever we change a diet suddenly, it takes the body a bit to become accustomed to the new regimen. You can kill sheep by suddenly giving them a lot of grain, for example. They need time to build up a new grain-loving bacterial population in the rumen.

So if you're speaking of the Atkins induction period, with a sudden change in diet plus very very strict carb control, that's one thing. Chronic LC dieting is different.

You didn't clarify that but referred to "among low carbohydrate dieters," so I misunderstood what you were suggesting.

Most LC gurus suggest adding salt on LC diets, and especially in the initial stages.

Anonymous said...

What about Lite Salt, which contains potassium chloride, as a source of potassium?

Ned Kock said...

I see Gretchen, good points.

Ned Kock said...

Hi Anon. I have occasionally seen these types of comments about potassium-based salt substitutes:

http://www.straightdope.com/columns/read/1364/can-salt-substitute-kill-you

Enough to be somewhat alarmed, I’d say.

Nick said...

Hi Ned,

If one can assume the serum ref range is a proper estimate of what potassium levels should be, and they are in range, what is the likelihood that one needs to concern themselves with monitoring intake?

Ned Kock said...

Hi Nick. You can get out of range in as little as a few days. The triggers may be a new strict diet, physical activities that are unusually demanding, a very stressful period at work or home, to name a few.

David Isaak said...

I have always steered clear of potassium chloride. If I want to supplement, I use Electro-Mix, a balanced electrolyte mix (except for the lack of sodium!), stir-it-into-a-drink, fizzy concoction based on potassium carbonate & bicarbonate:

http://www.emergenc.com/index.php/products/specialty/electro-mix

There are interesting correlations between low potassium status, adiponectin, and metabolic syndrome:

http://www.nature.com/ajh/journal/v20/n8/full/ajh2007246a.html

(Alas, just the abstract...)

Ned Kock said...

The second seemed to be the full article David, or maybe my connection gave me access to it. Interesting graphs there of adiponectin levels and IR; suggesting a strong negative relationship.

mem said...

Coffee is VERY high in potassium. A cup or two in the am should very neatly take care of the problem. And this applies to decaf as well.

mem said...

Also, the original Atkins induction, which ran for two weeks, did NOT allow a variety of vegetables, but only for the first two weeks. It allowed like two cups of plain lettuce only per day.Period.

Ned Kock said...

Hi mem. Two cups of regular coffee will give you about 1/3 of the potassium in a medium-sized white potato, which is itself less than 20 percent of the officially recommended amount. This is according to data from Nutritiondata.com.

mem said...

Hi Ned,

Oops...my source broke down potassium per 200cal servings! So, that is a lot of coffee at 2.4 cal for about a 6 oz serving, lol! And it was: 10801mg for decaf brewed at home and 9799 for caf. Although it seemed very high, it sped right past me as over in the years in ERs I've seen many people with shooting high K+ in part due to HUGE daily coffee intakes - the 10+ cups a day set. Thanks for the correction! (Source: Self Nutrition Data)

M & M said...

In studies on rats a protein-fat diet at 75% energy fat, 20% protein and 5% carbohydrates - decreased demand for protein by 35%, energy by 34%, the minerals by 68%
www.dr-kwasniewski.pl/media/2/bib-1/krystyna.txt_3/news_444.doc

M & M said...
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Kindke said...

Blah that article is in polish.

M & M said...

The increase in carbohydrate intake, increased levels of insulin increases the demand for vitamins (B1)and minerals (Mg), and proteins (Glycolysis)

Does Diabetes Mellitus Increase the Requirement for Vitamin C?
http://onlinelibrary.wiley.com/doi/10.1111/j.1753-4887.1996.tb03932.x/abstract

Vitamins are small biomolecules that are needed in small amounts in the diet of higher animals.
Stryer Biochemistry

M & M said...

http://www.health-science-spirit.com/HF5-2.gif

Mottdog said...

Well magnesium is needed to hold potassium into solution.

pharmacy reviews said...

I have read that some races of people can't absorb properly some proteins and that's why they need following by doctors.