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Increase sodium, potassium or both in ketosis? (edit: title changed)

by (30)
Updated about 12 hours ago
Created November 25, 2011 at 9:45 AM

Hi fellow paleotics! :)

I have been following a low-carb paleo diet the last three years being in ketosis most of the time and feel great. At times I have been suffering from the dreaded ketosis fatigue or brainfog, most likely related to electrolyte imbalances in my body.

I have tried to supplement by remineralizing my drinking water with either sodium chloride or potassium chloride and noticed (maybe placeboic) improvements.

I am 178 cm tall, weigh 78 kg and my BF ~15 %. I lift heavy wheights once a week.

Dr Eades says:

Potassium is linked to sodium. If you lose a lot of sodium through the diuretic effect of the low-carb diet, you???ll ultimately lose a lot of potassium as well. Keeping your sodium intake up as mentioned above will help preserve your potassium as well. And keeping your potassium levels up helps to ensure that you don???t lose a lot of lean muscle mass during your weight loss. Plus, just as with sodium, adequate potassium prevents cramping and fatigue. (Link)

Thus: If your intake of sodium is adequate, do not bother with potassium?

But this paleohack thread indicates the opposite (link)

What is the ideal ratio of potassium to sodium? Pretty high actually. 8:1? More? Our chronic deficiency of potassium may have significant consequences for declining energy levels and hypertension.

Thus: Increase potassium intake?

Therefore my question is: What is most important to keep track of, sodium or potassium?

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3280 · February 08, 2012 at 10:52 PM

Low carb diets are absolutely diuretic, specifically when you are low carb enough to be in ketosis.

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30 · November 25, 2011 at 12:05 PM

Thank you greyman for your answer. I changed the title after reading your comment regarding adding to water. Of course it could be added to food as well.

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1130 · November 25, 2011 at 11:27 AM

Low carb do have a diuretic effect, since you begin the diet and then lasting a few weeks. At least that's what common.

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1130 · November 25, 2011 at 11:37 AM

Erik, According to my own experience, as well as the book "The Art and Science of Low Carbohydrate Living", you need to ensure enough intake of electrolytes in low carb diet.

Regarding the sodium, the authors of the book recommend 5g per day (which is quite a lot). I don't see why you would have to add it to drinking water - in my understanding, what one should do is to add enough salt to one's food, or in other words, do not under-salt. Usually, when I buy lunch in a cafeteria for example, I use to add a bit more salt.

Regarding the potassium, the authors also prescribed mineral and vitamin supplements to the patients in their clinic, where they treated them with low carb diet. In my understanding, paleo diet is quite rich in potassium, so you should be safe here.

I can't guess what's your case is exactly, but I had those symptoms you mention when I lost a lot of sodium during hiking and didn't know I need to "refill" it. When a lot of sodium is lost, the body will flush other minerals as well to keep balance. So in my own case, eating enough salt was sufficient to correct the imbalance. I don't keep track of the ratios.

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30 · November 25, 2011 at 12:05 PM

Thank you greyman for your answer. I changed the title after reading your comment regarding adding to water. Of course it could be added to food as well.

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20353 · November 25, 2011 at 10:07 AM

Look at cronometer for a few days and see where you are coming out at. 8:1 is great on the ratio. Magnesium is important for your potassium levels as well. I have almost no salt in my diet. Potassium I do OK on. Yours will be differ from mine for sure.

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10 · February 08, 2012 at 10:43 PM

@Huey - protein is a diuretic.

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0 · May 29, 2013 at 8:28 AM

Some people get very thirsty from low-carb ketosis. Drinking large amounts of plain water will lessen the build-up of ketones but increase the challenge of maintaining electrolytes.

In some low-carb dieters, there is a vicious cycle, where a mild loss of electrolytes causes greater thirst and greater water consumption, and the greater amount of water makes the electrolytes worse. It's sometimes possible for people to consume really extreme amounts of water without realizing their thirst signals are out of whack.

Simultaneous with the thirst issues, people might consume unusually low-sodium or unusually high-sodium foods, so the eventual problem might be global electrolyte problem or it might be an imbalanced ratio, such as the ratio of sodium to potassium.

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8270 · February 09, 2012 at 8:41 AM

It's a bit twofold. Yes it's diuretic, and no it's not diuretic. It just depends on the timing. What happens when you go low carb is you reduce the amount of glycogen in your body. Less glycogen = less water retention = you pee out more of what you drink.

So when you start a low carb diet from a high carb diet, you're cutting down the glycogen, causing you to pee out the water bound to that glycogen. Once you're low carb and low glycogen, you're just peeing out the water you drink.

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2936 · November 25, 2011 at 10:55 AM

Since when does low carb have a diuretic effect?

Low carb is indeed deficient in those electrolytes (by SAD standards), but that shouldn't be a problem without outside diuretics to screw things up. That's my understanding, anyway.

Disclaimer: I was a coffee abuser for too long (it's a diuretic), so I have no personal experience at being in equilibrium.

3432683fc74c2d2a40efe1e8f16ac1f6
1130 · November 25, 2011 at 11:27 AM

Low carb do have a diuretic effect, since you begin the diet and then lasting a few weeks. At least that's what common.

Fb67dc30cead043d1d13ea503a3044dc
3280 · February 08, 2012 at 10:52 PM

Low carb diets are absolutely diuretic, specifically when you are low carb enough to be in ketosis.

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