Potassium Deficiency

What Is Potassium?

[dropcap]P[/dropcap]otassium is a mineral that is crucial for life being essential for every cell, especially nerve and muscle function.

Most potassium is intracellular, meaning it is found within cells while sodium, its opposing mineral (both electrolytes), is found in the fluid surrounding cells.

In muscle contraction, exchange of potassium and sodium takes place so that potassium moves out of muscle cells and sodium moves into them.

With muscle relaxation, potassium moves back into the cells and sodium moves out. Functions are described below.

Importantly, a recent study investigating the association between the metabolic syndrome and potassium intake in the general population found a significant inverse association between potassium intake and metabolic syndrome in adults. That is, the lower the potassium intake, the greater the odds of developing metabolic syndrome. After adjusting for various lifestyle and dietary confounders, subjects in the highest quartile of potassium intake had 39% lower odds for metabolic syndrome compared to those in the lowest quartile. This association was consistent for both sexes. Among the components of metabolic syndrome, potassium intake was inversely related to abdominal obesity and fasting hyperglycemia in multivariate analysis.¹

What Is Potassium Deficiency In Celiac Disease and/or Gluten Sensitivity?

• Relationship between potassium deficiency and celiac disease. Potassium deficiency is a classic symptom of celiac disease that results when the level within cells is too low to meet needs of the body for this mineral.
• Relationship between potassium deficiency and dehydration. Potassium deficiency is characterized by dehydration that may result in vascular collapse, muscular malfunction that may result in paralytic ileus, paralysis, and respiratory hypoventilation or failure, metabolic acidosis resulting from diarrhea, and impaired nerve conduction.²
• Relationship between potassium deficiency and celiac crisis. A severe acute diarrhea with metabolic and systemic complications, the so-called celiac crisis, is a possible presenting clinical feature due to potassium depletion of a previously undiagnosed adult celiac disease.³
• Relationship between potassium deficiency and defects of potassium absorption. The main routes for water and potassium absorption  in duodenal mucosa of celiac disease patient are deficient and may play a role in the onset of malabsorption symptoms. Research showed that in healthy controls, immunohistochemistry revealed a labelling in the apical membrane of surface epithelial cells of the duodenum. However, the immunolabelling was heavily reduced or absent in untreated celiac patients, while it was normal in patients consuming a gluten-free diet for at least 12 months.⁴

How Prevalent Is Potassium Deficiency In Celiac Disease and/or Gluten Sensitivity?

Potassium deficiency affects 100% of  patients with untreated celiac disease.⁵

What Are The Symptoms Of Potassium Deficiency?

Potassium deficiency is marked by these symptoms:

• Low blood pressure.
• Dizziness.
• Anorexia.
• Thirst.
• Vomiting.
• Tremor.
• Muscle spasm.
• Weakness of the lower extremities.
• Drowsiness.
• Anxiety.
• Confusion.
• Personality changes.
• Depression.
• Bone pain.
• Premature ventricular and atrial contractions.
• Contributes to osteoporosis.

Acute severe deficiency causes rhabdomyolysis (muscle destruction) and paralysis which can include the lungs, and can lead to serious heart rhythm problems that can be fatal.

Late symptoms include tetany, myoclonic jerks, convulsions, and kidney damage (hypokalemic nephropathy).²

What Does Potassium Do In The Body?

1.  Maintains electrolyte balance.
2.  Maintains acid-alkali balance (pH).
3.  Maintains fluid balance, preventing water retention.
4.  Essential for nerve transmission and muscle function.
5.  Essential for enzyme activities.
6.  Essential for red cell transport of carbon dioxide.
7.  Essential for protein synthesis and the conversion of glucose into glycogen for energy.
8.  Essential for moving nutrients into cells and waste products out of cells.
9.  Essential for bone structure.
10. Essential for cardiovascular function and regulating blood pressure.
11. Essential for stability of cell structure.

How Does The Body Get Potassium?

• Potassium is readily absorbed by the small intestine.²
•  Against ongoing nutritional education, the vast majority of US adults consume too much sodium and too little potassium.⁶
• However, the fault is compounded in celiac disease because potassium absorption is impaired.

How Does Potassium Deficiency Develop?

Potassium deficiency results from these mechanisms:

• Malabsorption due to inflammation of intestinal lining.
• Malabsorption can occur as a consequence of low stomach acid. Sufficient acid is required to ionize potassium (receives a positive charge) which is required for absorption later in the small intestine.
• Malabsorption can occur as a consequence of insufficient carrier proteins needed to transport ionized potassium into the bloodstream from the absorbing cells of the small intestine.
• Depletion in diarrhea, sweating, vomiting, and excessive urination when present.
• Magnesium deficiency contributes to potassium deficiency.⁷

Does Potassium Deficiency Respond To Gluten-Free Diet?

Yes. Celiac disease-related potassium deficiency resolves on nutritious gluten free diet containing adequate potassium.

6 Steps To Correct Potassium Deficiency:

• [dropcap]1[/dropcap]Meet, or Exceed the Adequate Intake (AI) for Potassium set by The Institute of Medicine: 

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0-6 months 400 mg/day; 7-12 months 700 mg/day

1-3 years 3,000 mg/day

4-8 years 3,800 mg/day

9-13 years 4,500 mg/day;

14 years and  older 4,700 mg/day

Pregnant women 4,700 mg/day; Breastfeeding women 5,100 mg/day[/box]

• [dropcap]2[/dropcap]Diet – Include Food Sources Richest in Potassium:

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Food Sources of Potassium ranked by milligrams of potassium per standard amount, also showing calories in the standard amount. (The AI for adults is 4,700 mg/day potassium.)

Food, Standard Amount	Potassium (mg)	Calories
Sweetpotato, baked, 1 potato (146 g)	694	131
Tomato paste, ¼ cup	664	54
Beet greens, cooked, ½ cup	655	19
Potato, baked, flesh, 1 potato (156 g)	610	145
White beans, canned, ½ cup	595	153
Yogurt, plain, non-fat, 8-oz container	579	127
Tomato puree, ½ cup	549	48
Clams, canned, 3 oz	534	126
Yogurt, plain, low-fat, 8-oz container	531	143
Prune juice, ¾ cup	530	136
Carrot juice, ¾ cup	517	71
Blackstrap molasses, 1 Tbsp	498	47
Halibut, cooked, 3 oz	490	119
Soybeans, green, cooked, ½ cup	485	127
Tuna, yellowfin, cooked, 3 oz	484	118
Lima beans, cooked, ½ cup	484	104
Winter squash, cooked, ½ cup	448	40
Soybeans, mature, cooked, ½ cup	443	149
Rockfish, Pacific, cooked, 3 oz	442	103
Cod, Pacific, cooked, 3 oz	439	89
Bananas, 1 medium	422	105
Spinach, cooked, ½ cup	419	21
Tomato juice, ¾ cup	417	31
Tomato sauce, ½ cup	405	39
Peaches, dried, uncooked, ¼ cup	398	96
Prunes, stewed, ½ cup	398	133
Milk, non-fat, 1 cup	382	83
Pork chop, center loin, cooked, 3 oz	382	197
Apricots, dried, uncooked, ¼ cup	378	78
Rainbow trout, farmed, cooked, 3 oz	375	144
Pork loin, center rib (roasts), lean, roasted, 3 oz	371	190
Buttermilk, cultured, low-fat, 1 cup	370	98
Cantaloupe, ¼ medium	368	47
1%-2% milk, 1 cup	366	102-122
Honeydew melon, 1/8 medium	365	58
Lentils, cooked, ½ cup	365	115
Plantains, cooked, ½ cup slices	358	90
Kidney beans, cooked, ½ cup	358	112
Orange juice, ¾ cup	355	85
Split peas, cooked, ½ cup	355	116
Yogurt, plain, whole milk, 8 oz container	352	138

Source: Nutrient values from Agricultural Research Service (ARS) Nutrient Database for Standard Reference, Release 17. Foods are from ARS single nutrient reports, sorted in descending order by nutrient content in terms of common household measures. Mixed dishes and multiple preparations of the same food item have been omitted from this table. [/box]

• [dropcap]3[/dropcap] Diet – Avoid  or Limit These Foods That Deplete or Interfere With Absorption:

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• Excessive salt use.
• Caffeine from coffee, tea, and drinks such as soda containing it depletes potassium through excess urination.
• Alcohol.

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• [dropcap]4[/dropcap]Monitor Medications That Deplete or Interfere With Absorption:

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Here are common medications that deplete potassium. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others).
• Loop Diuretics (Lasix®, Bume®x, Edecrin®).

ANTIVIRAL AGENTS

• Foscanet. 

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac®.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®).
• Prevacid®, Prilosec®.
• Alka Seltzer®, Baking Soda. [/box]

• [dropcap]5[/dropcap]Manage Nutritional Supplements to Obtain Potassium:

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• A blood level concentration  should be obtained to determine status before supplementing.
• Potassium is available in tablet, powder and liquid form and as part of multivitamin/mineral supplements.

Caution: Consult doctor before using potassium supplements in amounts exceeding that in multivitamin/mineral supplements. [/box]

• [dropcap]6[/dropcap]Other Supplements That Deplete or Interfere With Absorption:

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• Sodium. Check with your pharmacist.

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Medical Research Findings On Potassium Deficiency In Celiac Disease and/or Gluten Sensitivity:

RESEARCH STUDY SUMMARIES

“Benefits of potassium intake on metabolic syndrome: The fourth Korean National Health and Nutrition Examination Survey (KNHANES IV).” This study investigating the association between the metabolic syndrome and potassium intake in the general population found a significant inverse association between potassium intake and metabolic syndrome in adults. After adjusting for various lifestyle and dietary confounders, subjects in the highest quartile of potassium intake had 39% lower odds for metabolic syndrome compared to those in the lowest quartile. This association was consistent for both sexes. Among the components of metabolic syndrome, potassium intake was inversely related to abdominal obesity and fasting hyperglycemia in multivariate analysis (p for trend = 0.049 and 0.010, respectively).

Participants were 7542 adults older than 20 years of age from the fourth Korean National Health and Nutrition Examination Survey (2007-2009), which is a cross-sectional survey of a nationally representative sample of the Korean population. Data were obtained from standardized questionnaires as well as physical and laboratory examination reports. The 24-h recall method was used for dietary assessment. Metabolic syndrome was defined based on the modified National Cholesterol Education Program-Adult Treatment Panel III criteria. Multivariable logistic regression was performed to estimate the odds of metabolic syndrome and its components across potassium intake quartiles.¹

“Solute transporters and aquaporins are impaired in celiac disease.” This study investigating the possible alteration in the expression and localization of water channels and some solute transporters in duodenal mucosa of celiac disease patients show that the main routes for water and solute absorption such as potassium are deficient in celiac disease and may play a role in the onset of malabsorption symptoms.

Duodenal biopsies from untreated celiacs, treated celiacs, healthy controls and disease were examined. The expression of transcripts was virtually absent in duodenal biopsies of untreated celiac disease patients. In healthy controls, immunohistochemistry revealed a labelling in the apical membrane of surface epithelial cells of the duodenum. The immunolabelling was heavily reduced or absent in untreated celiac patients, while it was normal in patients consuming a gluten-free diet for at least 12 months.⁴

CASE REPORT SUMMARIES

“Celiac crisis with quadriplegia due to potassium depletion as presenting feature of celiac disease.” This case report describes a 26-year-old who woman presented with a suddenly developed weakness of all four limbs and a severe diarrhea. Authors emphasize coeliac crisis, which is a presenting feature of coeliac disease, characterized by acute diarrhea with life-threatening acid base and electrolyte abnormalities. The patient improved with correction of hypokalemia (low blood potassium) and gluten-free diet. A severe acute diarrhea with metabolic and systemic complications, the so-called coeliac crisis, is a possible presenting clinical feature due to potassium depletion of a previously undiagnosed adult celiac disease.³

Sources:

1. Shin D, Joh HK, Kim KH, Park SM. Benefits of potassium intake on metabolic syndrome: The fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Atherosclerosis. 2013 Sep;230(1):80-5. doi: 10.1016/j.atherosclerosis.2013.06.025. [↩] [↩]
2. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩] [↩] [↩]
3. Atikou A, Rabhi M, Hidani H, El Alaoui Faris M, Toloune F. Celiac crisis with quadriplegia due to potassium depletion as presenting feature of celiac disease. Rev Med Interne. 2009 Jun;30(6):516-8. doi: 10.1016/j.revmed.2008.11.012. [↩] [↩]
4. Laforenza U, Miceli E, Gastaldi G, Scaffino MF, Ventura U, Fontana JM, Orsenigo MN, Corazza GR. Solute transporters and aquaporins are impaired in celiac disease. Biol Cell. 2010 May 26;102(8):457-67. doi: 10.1042/BC20100023. [↩] [↩]
5. Molteni N, Bardella MT, Vezolli G, Pozzoli E, Bianchi P. Intestinal calcium absorption is shown by stable strontium test in celiac disease before and after gluten-free diet. American Journal of Gastroenterology. Nov. 1995; 90(11):2025-8. [↩]
6. Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, Yang Q, Moshfegh AJ. Sodium and potassium intakes among US adults: NHANES 2003-2008. Am J Clin Nutr. 2012 Sep; 96(3):647-57. doi: 10.3945/ajcn.112.034413. [↩]
7. http://www.nlm.nih.gov/medlineplus/ency/article/000479.htm [↩]