Managing Potassium and Sodium On a Ketogenic Diet

A well-formulated ketogenic diet (WFKD) requires real food choices and preparation to maintain an optimum potassium intake.

Blog - Sept. 20 picture.

The sodium and potassium management by the kidneys and the changes in sodium handling during nutritional ketosis is makes this especially important.

Potassium and Mortality in the Balance

Potassium is the positively charged ion (aka electrolyte) that is predominate in the fluid inside all of the body’s cells, while sodium plays a matching role in the fluid surrounding our cells – including blood plasma. Keeping the two of them in balance is involves multiple hormones and organs, particularly the kidneys.

In order for nerves and muscles to function, the concentrations of positively charged potassium (K+) and sodium (Na+) have to be essentially equal across the cell membranes. If either this balance, or the in-and-out flow of these two electrolytes is impaired, nerves and muscles don’t work properly, endangering health and even life itself.

Because part of sodium’s role in the plasma is to maintain adequate circulation, it has been well characterized as necessary for normal blood flow. And in the case of high blood pressure, it is tempting to conclude that one just needs to restrict sodium intake to get it to come back down. While there is some truth to this (for people with salt-sensitive hypertension), for most people with high blood pressure, it involves the appropriate balance between these two electrolytes rather than a focus on the intake of sodium in isolation.

Recently, large studies have measured the actual amounts of sodium in a person’s urine. The most definitive results to date are from the massive international PURE study reported by O’Donnell et al. In this study, they collected urine from 102,000 people in 17 countries and then monitored health and mortality for 4 years. The lowest mortality was seen in people consuming 5 grams per day, which is about twice the current US recommended guideline for healthy adults. For sodium intakes substantially above or below this value, the associated mortality rates rise, generating a U-shaped curve.

See The Estimated Sodium Excretion chart below. *

Blog - Sept 20 chart 1

But the urinary potassium data from the PURE Study (See The Roles of Vegetables and Broth in Reducing Risk of Death chart below) tell a very different story. While low levels of potassium excretion are clearly associated with increased mortality risk, increasing levels in the urine up to 3-4 grams per day correlate with reduced risk. And in particular, the associated mortality at 1 gram per day is about double that seen at 3 grams per day. For this reason, we recommend incorporating real foods into a WFKD providing 3-4 grams per day of potassium.

See the Roles Of Vegetables And Broth In Reducing Risk Of Death chart below **

Blog - Sept 20 chart 2

The Relationship Between Sodium and Potassium Intakes and Urinary Excretion

Almost all of the sodium we eat gets absorbed, and then about 90% of that comes out in our urine. Therefore, urinary sodium is an accurate reflection of our dietary intake.

However, this relationship between dietary intake and urinary output is not quite as good for potassium. In most people, about 75% of dietary potassium is excreted in the urine. Thus, in the studies linking urinary potassium excretion to health a correction factor of about 1.3 should be applied. This means that in order to have 2 grams of potassium come out in the urine, one would need to consume 2.6 grams in the diet, and similarly to have 3 grams in the urine would require about 4 grams of dietary intake.

Practical Health Implications of Dietary Potassium

An important point to note here is that processing of meat to create luncheon meat, hot dogs, or bacon removes much of the potassium originally associated with that protein source and therefore should be restricted. In addition, if unprocessed protein sources are boiled or stewed, some of the potassium they contain comes out in the broth. Thus they should be prepared and served such that the broth or sauce is consumed to get the full benefit of their electrolytes and minerals.

Official Dietary Potassium Guidelines

The great majority of the population eats far less than the current estimated Adequate Intake value of 4.7 grams.

The reason it is only an estimate is because when dietary sodium is restricted, the kidneys tend to excrete more potassium to maintain the balance. This process is regulated by a series of hormones, with the main one being the stress hormone aldosterone. On average a sodium-restricted diet given to people with normal blood pressure increases this stress hormone more than 3-fold.

Getting Enough Potassium with a WFKD

From what we currently know about potassium needs for someone getting adequate sodium on a WFKD, 3 to 4 grams per day, appears to be an appropriate target to provide the necessary amount of potassium for health-related benefits.

This is an amount that is achievable with real foods.To begin, the right choices of protein that are prepared correctly will provide the first gram. On average, non-starchy vegetables that are consumed raw, sautéed or steamed contain about 200 mg per standard serving, so 4-5 servings of vegetables per day will provide the second gram. Nuts and seeds vary in their potassium content but range from 100-300 mg per ounce (oz), so 2 oz per day moves the scale closer to the 3 g per day optimum target.

Broth

The amount of potassium in home-made broth will vary depending upon how much meat remains on the bones used to prepare the broth. Typically, a pound of chicken carcass or meaty beef bones used to make a quart of broth will contain 200-300 mg of potassium per cup.

Technical Information on the Regulation of Electrolyte Balance

It is known that both total fasting and a ketogenic diet lead to an accelerated sodium excretion that increases water and salt loss through the urine. If this lost sodium is not replaced, the kidneys will reabsorb sodium. This process comes at the price of increased potassium excretion.

With consistent loss of potassium and/or chronically low intake of potassium the body will attempt to correct via the release of intracellular potassium from skeletal muscle.

It is clear that maintaining sufficient sodium and potassium intakes from the diet serves a number of important functions: potential mitigation of risk for cardiac events, preservation of plasma volume and muscle mass, and prevention or reduction of symptoms of the ‘keto- flu’.

The fail-safe endocrine system responsible for the tight regulation of electrolytes is commonly referred to as the renin-angiotensin-aldosterone system (RAAS). When plasma sodium levels are low (an intake of less than 3 grams per day), when blood potassium levels are significantly elevated (hyperkalemia), or when there is a notable reduction in blood pressure, RAAS is activated.

The cost for frequent RAAS activation is increased oxidative stress, increased vascular damage, measurable dyslipidemia * and potential sleep and mood disturbances.

Dyslipidemia * is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low HDL cholesterol level that contributes to the development of atherosclerosis. Sourcehttps://www.merckmanuals.com/en-ca/professional/endocrine-and-metabolic-disorders/lipid-disorders/dyslipidemia

This compensatory activity of RAAS as well as increased sympathetic nervous system activity that together work to maintain electrolyte levels helps explain why we typically do not see a large decrease in blood pressure when sodium is restricted in most patients. In those who do not have salt-sensitive hypertension, these systems appear to adjust to dietary intake and manipulate sodium, potassium and fluid levels in order to maintain a person’s blood pressure.

The important role of potassium in muscle function and sodium in maintaining plasma volume are added considerations for individuals who exercise or engage in activity that results in a large volume of sweat loss. Due to the loss of Na+ and K+ in sweat, these circumstances may require additional electrolyte replacement in order to maintain performance, especially for those following a ketogenic way of eating. A good rule of thumb is about ½ tsp of salt 30 minutes prior to exercise and if exercise is performed at a relatively-high intensity in a hot environment, an additional ½ tsp of salt each hour may be warranted.

 For better health and well-being on a WFKD consume the recommended amounts of the electrolytes, sodium 3-5 g and potassium 3-4 g per day, will help support overall health as well as the success and sustainability of nutritional ketosis.

Talk to your doctor about your sodium and potassium needs, if you are taking a diuretic medication (aka, a water pill), if you have high blood pressure, if you have any impairment in kidney function, or if you have limited heart function (such as congestive heart failure).

This Post has been condensed fromThe Importance of Managing Potassium and Sodium as Part of a Ketogenic Diet by Stephen Phinney, MD, PhD, Jeff Volek, PhD, RD. Please see the original post for the scientific citations.

https://blog.virtahealth.com/potassium-sodium-ketogenic-diet/

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

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May you Live Long Healthy.

Yours truly,

Lydia Polstra

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Keto-Adaptation – Some Clues to Its Complexity

Human metabolism has evolved to be remarkably flexible in its ability to use a variety of dietary energy substrates. From a cultural history perspective, humans have demonstrated the ability to subsist for generations on up to 80% of dietary energy as carbohydrates at one end of the macronutrient spectrum to over 80% as fat (a ketogenic diet) at the other end. Given this wide range of dietary options, what is the optimum nutrient mix? Is one end of this spectrum better than the other? Or is it best to be somewhere in the middle? How long does human metabolism take to optimize its use of the dominant fuel provided? We know that a lot of disease symptoms and health indicators get much better soon after someone starts on a ketogenic diet.

Most people, including most nutrition scientists, appear to believe that the effects of a high fat diet can be determined after only a week or two. Thus most diet studies, particularly those assessing effects on physical performance, have typically been run for two weeks or less. And this is still the case, even though we published data over 3 decades ago showing that the process of adapting to a very low carbohydrate intake requires at least a month and likely quite a bit longer. How much longer? It depends upon what measure of adaptation one is following, and it is very likely that inter-individual variability is a factor as well.

While a ketogenic diet can put you into a state of nutritional ketosis in a matter of days, it can take weeks to months to become fully keto adapted.

How Long Does it Take to Optimize Ketone Metabolism?     Some assume that keto-adaptation occurs simultaneously with the build-up in the level of ‘ketones’ (beta-hydroxybutyrate) in the blood. This hypothesis is based on the assumption that all of the benefits of ketones are directly linked to the amount available in the circulation. But here’s the catch – in our controlled inpatient studies, blood levels of BOHB come up to a new steady state within a week of starting a ketogenic diet but one’s subjective and objective ability to do vigorous exercise takes anywhere from several weeks to a few months to recover and then stabilize. In other words, the process of keto-adaptation that allows for normal or increased exercise performance lags well behind the level of ketones in the blood.

The body’s ability to produce and defend muscle glycogen via gluconeogenesis can become finely tuned, but that this takes much longer than 4-6 weeks to occur.

Serum Uric Acid as a Biomarker for Keto-adaptation: An intriguing potential indicator of the body’s progress into keto-adaptation is the response of the serum uric acid content after initiation of a ketogenic diet. In healthy normal humans with initially normal blood uric acid levels, their values typically double in the first week of nutritional ketosis.

The figure below depicts the serum uric acid levels typical for a healthy person fed a moderate protein ketogenic diet for 12 weeks. The acute rise in the first week occurs simultaneously with the increase in blood ketones, but then the slow progressive decline occurs despite stable levels of dietary protein and blood ketones.

Blog May 31 keto chart -1.png

In other words, the initial rise in blood uric acid appears linked to the onset of nutritional ketosis, but then the body slowly adapts back to normal uric acid clearance despite sustained ketones in the blood.So what gives?

The best available answer to this question is the following: to protect the body’s acid-base balance against too much acid from the diet or produced by our metabolism, our kidneys have the capacity to identify and actively clear organic acids from the blood. To some degree, at the onset of nutritional ketosis, this seems to be indiscriminate – it treats uric acid and non-toxic levels of ketones all the same. So at the start of nutritional ketosis, these two organic acids compete for excretion, causing blood uric acid to rise despite no increase in its production.

Over time the kidneys adapt to normalize uric acid excretion in the presence of beta-hydroxybutyrate, this process takes a few months to occur.

During this recovery in the kidney’s handling of organic acids, other aspects of the body’s energy regulation and homeostasis are undergoing similar slow changes as well with the net effect resulting in the process of ‘keto-adaptation’.

Does Keto-adaptation Increase Mitochondrial Density?         Another potential structural change that might directly contribute to keto-adaptation would be an increase in mitochondrial density in muscle, brain, and other oxidative tissues. The dramatic shift in energy metabolism towards fatty acid and ketone oxidation would be expected to enhance mitochondrial function. This could occur by increased mitochondrial biogenesis (production of new mitochondrial), decreased mitochondrial damage and autophagy (mitochondrial breakdown).

It is understood that reactive oxygen species (ROS) cause structural and functional damage to mitochondria, and that nutritional ketosis decreases mitochondrial ROS production. This could result in a prompt increase in the lifespan of existing mitochondria.

Keto-adaptation as a Complex of Changes on Varying Timelines: To be sure, when someone initiates a well-formulated ketogenic diet, a number of changes are set in motion which may occur in parallel, but with widely varying rates of completion.  (For these changes click the Virta link below.)

Bottom line: Keto-adaptation will likely be defined as the net effect of many parallel responses to a well-formulated ketogenic diet, with these various responses occurring on differing timelines, and to differing degrees across individual phenotypes/genotypes. The timeline for full keto-adaptation will likely be measured in months rather than days or weeks.

Have more questions about nutritional ketosis? Check out Nutritional Ketosis and Ketogenic Diet FAQ https://2healthyhabits.wordpress.com/2018/11/02/nutritional-ketosis-and-ketogenic-diet-faq/

This Post has been condensed fromKeto-Adaptation by Stephen Phinney, MD, PhD and Jeff Volek, PhD, RD on January 23, 2018

https://blog.virtahealth.com/keto-adapted/

 I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

 I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Nutritional Ketosis and Ketogenic Diet FAQ

Part 1-1

Nutritional ketosis is a natural metabolic state in which your body adapts to burning fat rather than carbohydrates as its primary fuel. It is clinically proven to directly reduce blood sugar (as measured by HbA1c), improve insulin sensitivity (as measured by HOMA-IR) and reduce inflammation (as measured by white blood cell count and CRP).

FREQUENTLY ASKED QUESTIONS:

For the answers to these questions Written by Dr. Steve Phinney and the Virta Team, please copy and paste this link into your address bar https://blog.virtahealth.com/nutritional-ketosis-faq/

ALL ABOUT KETOSIS:

What is nutritional ketosis?

How do I get into nutritional ketosis?

How can I tell if I’m in nutritional ketosis?

What are ketones? What is ketogenesis?

What is keto-adaptation?

What does it mean to be fat adapted?

 KETOGENIC DIETS:

What is a ketogenic diet?

What can I eat on a ketogenic diet?

Why is sugar bad for you?

How many carbs can I eat on a ketogenic diet?

Should I count net carbs or total carbs?

Is a ketogenic diet healthy for everyone, not just people with diabetes or weight issues?

What is “keto flu” and how do I avoid it?

Should I take vitamins or supplements on a ketogenic diet?

How much sodium, potassium and magnesium should I have on a ketogenic diet?

How much protein should I eat on a ketogenic diet?

What are the best artificial sweeteners and sugar substitutes for a ketogenic diet?

Can I be vegetarian and still do nutritional ketosis?

Can I be vegan and still do nutritional ketosis?

Can I eat dairy on a ketogenic diet?

Can I eat gluten on a ketogenic diet?

Do I need to eat vegetables on a ketogenic diet?

Do I need fiber supplements on a ketogenic diet?

Can I eat whey protein on a ketogenic diet?

What can I eat at a Chinese restaurant on a ketogenic diet?

Can a ketogenic diet reverse type 2 diabetes?

KETOGENIC DIETS AND DIABETES:

Does a ketogenic diet reduce insulin resistance?

Can I reverse diabetic neuropathy, nephropathy, or retinopathy with a ketogenic diet?

Ketosis vs. Ketoacidosis: What’s the difference?

HEART HEALTH AND CHOLESTEROL:

Is a ketogenic diet safe for your heart?

What happens to your cholesterol on a ketogenic diet?

What happens to LDL cholesterol on a ketogenic diet?

What happens to triglyceride levels on a ketogenic diet?

Do statins decrease the production of ketones?

Is nutritional ketosis safe?

What is ketoacidosis?

Is it safe to increase salt intake on a ketogenic diet?

Is it safe to follow a ketogenic diet during pregnancy?

Is it safe to follow a ketogenic diet if you have no gallbladder?

Can I follow a ketogenic diet if I have no thyroid?

How does a ketogenic diet affect kidney stones?

Does a ketogenic diet increase your risk of gout?

Is fasting safe?

WEIGHT LOSS:

Does a ketogenic diet cause weight loss?

How do I break a weight loss plateau on a ketogenic diet?

Is dietary fat burned before stored fat on a ketogenic diet?

How can I lose belly fat on a ketogenic diet?

TROUBLESHOOTING A KETOGENIC DIET:

What causes muscle cramps on a ketogenic diet?

What do I do if I get diarrhea on a ketogenic diet?

How do I fix constipation on a ketogenic diet?

What causes keto rash and how do you fix it?

Why do ketone levels vary throughout the day?

What are the consequences of cheating or lapsing on a ketogenic diet?

How should I interpret and apply CGM data?

Fats and Oils:

Which fats and oils should I eat on a ketogenic diet?

Can I eat canola oil on a ketogenic diet?

What is the best ratio of MUFA, SFA and PUFA on a ketogenic diet?

Can I use olive oil as a cooking oil?

Is fat the most satiating macronutrient?

For the answers to these questions Written by Dr. Steve Phinney and the Virta Team, please copy and paste this link into your address bar https://blog.virtahealth.com/nutritional-ketosis-faq/ Have a question we haven’t answered? Email us your question at faq@virtahealth.com

To learn more please read the book the Dr. Phinney co-authored with Dr. Volek.    New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great Paperback – Mar 2 2010

https://www.amazon.ca/New-Atkins-You-Ultimate-Shedding/dp/1439190275/ref=pd_lpo_sbs_14_t_0?_encoding=UTF8&psc=1&refRID=32GFYZ6T1GBJA3TMR31G

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

If you are interested in following my postings, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before Follow is available.

As always, I am interested in your thoughts on these topics.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

lpolstra@bell.net