Potassium: Milliequivalents, Milligrams and 4 Hours of Conversion Confusion!

by Stephen

As we know in the 4 Hour Body Tim recommends supplementing “The Slow Carb Diet” with Potassium, Calcium and Magnesium.

Today, I want to spend some time talking about Potassium, because this is a topic that is extremely confusing. When I was constructing my “Listmania for slow-carb diet supplements” on Amazon I was overwhelmed and confused by how many options there were. I prescribe potassium chloride often in the form of K-Dur, and I usually write for 20 mEq tabs. This is not available over the counter.

I have recommended over the counter potassium many times but have always been confused about the mg to mEq conversions. This is important, whether you are supplementing a low carb diet or using supplemental potassium for medical reasons.

Because low potassium (hypokalemia) is rare, there is no RDA or RNI for this mineral. However, it is thought that 1600 to 2000 mg (40 to 50 milliequivalents [mEq]) per day for adults is adequate.

Remember:

  • The total amount of potassium that you get every day includes what you get from food and what you may take as a supplement. Read the labels of processed foods. Many foods now have added potassium.
  • Your total intake of potassium should not be greater than the recommended amounts, unless ordered by your doctor. In some cases, too much potassium may cause muscle weakness, confusion, irregular heartbeat, or difficult breathing.

A brief internet search on different types of potassium produced a lot of articles on Livestrong, which confused me even more. Plus, I don’t know if I should trust Lance anymore.

So I am going to save you time, this is what you really need to know: I have concluded, that in essence, your two main over the counter potassium TABLET options (Potassium Citrate and Potassium Gluconate) contain the same 3% daily allowance of potassium or roughly 2.53 mEq of potassium.

*This is despite the very confusing mg dosing on the bottles.

When you arrive at the vitamin isle there are several options but these are the two most common. I have included the prescription form (potassium chloride) as well for comparison.

To make this even more confusing you can find the above options in various different mg presentations. The supplement makers make very little effort to clarify the actual mEq of potassium. In fact I couldn’t find one that did. This is annoying, and makes me wonder who the heck is behind he packaging of these.

Anyway here is my breakdown:

  1. Potassium Gluconate (sold over the counter): A slightly more complex molecule than potassium chloride. It is roughly two times bigger than potassium chloride. Potassium gluconate is a loosely bound salt of potassium and gluconic acid. Gluconic acid is formed when glucose is oxidized. Because the bond between the potassium and the gluconate is so loose, the molecule dissolves easily in water.
    1. Potassium gluconate contains 4.3mEq per 1000mg
    2. OTC Potassium Gluconate 595mg/550mg is equivalent to roughly 2.53 mEq K+. If the bottle says 99mg Potassium Gluconate it is the same as the 595mg/550mg tab…Just labeled for confusion!
  2. Potassium Citrate (sold over the counter): Potassium citrate is produced by adding potassium bicarbonate or potassium carbonate to a solution of citric acid until effervescence ceases, filtering the solution and evaporating to granulation.
    1. Potassium citrate contains 9.8mEq per 1000mg
    2. It is sold over the counter as 99 mg but actually contains the same 3% daily value as the potassium gluconate (from 258.6 mg Potassium Citrate) is equivalent to the same 2.53 mEq of Potassium .
  3. Potassium Chloride: The chemical compound potassium chloride (KCl) is a metal halide salt composed of potassium and chlorine. Orally, potassium chloride is toxic in excess; If given intravenously it is used to stop someones heart, just think the death penalty here!
    1. Potassium chloride contains 13.4mEq per 1000mg. K-lyte is Potassium chloride.

Of note: on Amazon you will find potassium iodide (think Chernobyl) and powdered forms of all of the above. This can be a good options if you need higher doses. For example one teaspoon of potassium gluconate powder is equal to 540mg, or again, roughly 2.53 mEq.

This is what you need to know: You will get roughly 3% of your daily potassium allotment in one tab if you purchase either: Potassium Gluconate 550 mg / 595 mg Tablet or Potassium Citrate 99 mg Capsules They are essentially the same thing! This is the max dose sold in OTC tablet form in the US. Do not get confused by potassium gluconate labeling: 595, 550, 99 mg are all essentially the same thing!

So how much potassium is in the elusive potassium rich banana?

Click here to reveal the answer?

Whole Food Sources of Potassium:

Here is Tim’s list of slow-carb options, in descending order of concentration.

Tim’s recommendation of potassium: 4,700 mg per day recommended for an average, healthy 25-year-old male.

  1. Lima beans, cooked, 4.9 cups (1 cup = 969 mg)
  2. Chard, cooked, 4.9 cups (1 cup = 961 mg)
  3. Halibut, cooked, 2.6 fillets (half a fillet = 916 mg)
  4. Spinach, cooked, 5.6 cups (1 cup = 839 mg)
  5. Pinto beans, cooked, 6.3 cups (1 cup = 746 mg)
  6. Lentils, cooked, 6.4 cups (1 cup = 731 mg)
  7. Salmon, cooked, 3.4 fillets (half a fillet = 683 mg)
  8. Black beans, cooked, 7.7 cups (1 cup = 611 mg)
  9. Sardines, 7.9 cups (1 cup = 592 mg)
  10. Mushrooms, cooked, 8.5 cups (1 cup = 555 mg)

Here is a more comprehensive list from the Mayo Clinic:

Food (amount)Milligrams
of potassium
Milliequivalents
of potassium
Acorn squash, cooked
(1 cup)
89623
Potato with skin, baked
(1 long)
84422
Spinach, cooked
(1 cup)
83821
Lentils, cooked
(1 cup)
73119
Kidney beans, cooked
(1 cup)
71318
Split peas, cooked
(1 cup)
71018
White navy beans, cooked
(1 cup)
66917
Butternut squash, cooked
(1 cup)
58315
Watermelon
(1/16)
56014
Raisins
(½ cup)
55314
Yogurt, low-fat, plain
(1 cup)
53114
Orange juice, frozen
(1 cup)
50313
Brussel sprouts, cooked
(1 cup)
49413
Zucchini, cooked, sliced
(1 cup)
45612
Banana
(medium)
45112
Collards, frozen, cooked
(1 cup)
42711
Cantaloupe
(¼)
41211
Milk, low-fat 1%
(1 cup)
3489
Broccoli, frozen, cooked
(1 cup)
3329

I posted another list a while back here.

So there you have it. I hope I haven’t confused you more.

I created a pre-assembled slow carb diet supplement list on Amazon. This includes PAGG in combination with the 3 essential electrolytes, my choice of fish oil and vitamin D.

I will be discussing magnesium and calcium in a later post. Until then… Happy Slow Carb!

{ 15 comments… read them below or add one }

sasha September 5, 2013 at 5:37 pm

now im even more confused about how much potassium to take :( is there a way to get a straight answer lol, i have potassium gluconate, so how much a day do i take?

Reply

Stephen September 8, 2013 at 9:23 am

If you take 1-2 tabs daily with a normal diet you will be just fine. In most cases supplementation is not really necessary. It is only recommended as part of starting slow carb because people often experience some fluid loss. The potassium is meant to help prevent depletion, which is extremely rare in most cases! Thanks for pointing out the confusing nature of my article, reading it back again, even I was confused :-) Seemed so clear when I was writing it!

Best of luck, drop me a line if you ever have more questions.

Stephen

Reply

Melody U September 8, 2013 at 5:49 pm

For the sake of argument…if a person was eating only proteins and fats and absolutely nothing else, I’m assuming they would not be getting any potassium through their diet at all? If so, would they have to make that up by taking 4700mg of a potassium supplement?

Reply

Stephen September 8, 2013 at 7:22 pm

Great question Melody,

Potassium can also be found in fish, meat, and especially legumes. The chart in this blog post and in the 4 Hour Body touches on this briefly as well. In case you missed it here is a simple list:

Lima beans, cooked, 4.9 cups (1 cup = 969 mg)
Chard, cooked, 4.9 cups (1 cup = 961 mg)
Halibut, cooked, 2.6 fillets (half a fillet = 916 mg)
Spinach, cooked, 5.6 cups (1 cup = 839 mg)
Pinto beans, cooked, 6.3 cups (1 cup = 746 mg)
Lentils, cooked, 6.4 cups (1 cup = 731 mg)
Salmon, cooked, 3.4 fillets (half a fillet = 683 mg)
Black beans, cooked, 7.7 cups (1 cup = 611 mg)
Sardines, 7.9 cups (1 cup = 592 mg)
Mushrooms, cooked, 8.5 cups (1 cup = 555 mg)

That being said, your kidneys are very selective of how much potassium they let out and keep in. People with kidney disease can become extremely hyper or hypokalemic which can be a hallmark of their condition. They are no longer able to self regulate due to poor renal function.

This is why you could fast for 5 days and see no noticeable change in your serum potassium levels. Your body will just stop excreting it in your urine. Unless of course you found yourself with a case of the runs, in which case you better get some medical attention.

Most sources will say that people in America are potassium deficient. This is because many American eat a diet high in processed foods which are notoriously low in potassium. But if you eat a healthy well rounded diet, especially the 4-Hour Body diet you should be just fine. The OTC doses of potassium that you find without prescription have so little potassium I feel they would offer very little benefit (besides to the maker of the vitamin :-))

Also, I have probably read 1000′s if not 100′s of thousands by chemistry levels on my patients. Very, very rarely do we see abnormal potassium levels in healthy patients. Even in those who eat poorly. So maybe some of the claims are based more on speculation rather than solid evidence.

Eat healthy, add in lots of legumes and foods like salmon if you are anti vegetable and again, I think you should be just fine.

Great question,

Stephen

Reply

Melody Upham September 9, 2013 at 5:14 am

Thank you, Stephen. I am a diabetic and have found the only way to control it without medication is to eat only proteins (63gm per day) and fats. Even the smallest amount of non-starchy vegies shoves me high enough they want me on medication. After reading ‘Trick or Treat’, I decided to dump the vegies. I do eat fish though, so looks like I should be fine. Thanks for your quick response.

Reply

Stew August 3, 2014 at 12:41 am

4,700 is the RDA, that isn’t a number Tim thought of on his own. Or was Tim a scientist going by a pseudonym who wrote the original report stating the RDA is 4,700?

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jenn August 9, 2014 at 1:07 am

I was prescribed 25 meq. I’m wondering if buying potassium gluconate OTC would be more cost efficient. However, after reading this, I believe I would have to take 9 of the p.g. 595 mg pills to equal the prescription 25 meq. Is my understanding correct? Thank you!

Reply

John August 28, 2014 at 9:27 pm

The FDA only allows 99mg of potassium, as the pill form can damage the intestines, stomach. Taking more than a few pills can eat away at your organs, because it will sit there and dissolve. I am diabetic as well. Unfortunately, it looks like fish and other non-starchy vegetables on the list are the best way.

Reply

Stephen August 28, 2014 at 10:00 pm

Yes John thank you for answering Jenn’s question, you would not want to exchange OTC potassium tablets for a prescription form! Also, most people do not need supplemental potassium and it is fairly rare to come across people who are truly potassium deficient. I do see this in patients with hypertension or certain kidney problems and sometimes in diabetics as well, although more often than not my diabetic patients have too much potassium secondary to ace inhibitors. Make sure you actually need to take a potassium supplement, and I agree with you John, the best way to get your potassium is from natural sources, which both fish and non-starchy vegetables would be top of my list!

- Stephen

Reply

karen November 2, 2014 at 5:37 am

Where can I find this alarming information about the stomach intestinal damage?Is this only with over the counter K?

Reply

Gene September 8, 2014 at 4:42 pm

People who have uric acidosis often have to take 1080 meq 4 times a day. The drug companies have used a “control release formula ” to renew the patent, and raise the price to 4 x what it was before. Anyone out there compounding a solution to take 4 times a day? Any pharmacists doing it? If I could find someone who knows what they are doing, I could buy 500 g for $35, and pay a compounding fee, instead of paying $1500 per year for the prescriptions.

Reply

Stephen September 9, 2014 at 8:04 pm

Great question Gene. Dr. Robert Makki runs a podcast and website at http://www.progressyourhealth.com He is an integrative medicine Dr. and talks quite a bit about compounding medicines. If I were you I would go to his site or Facebook page and drop him a line. He may be able to put you in touch with a reputable pharmacist who could do this for you!

- Stephen

Reply

Karen November 2, 2014 at 5:29 am

THANK YOU FOR TRYING TO CLEAR THIS UP! THE ARTICLE HAS HELPED BUT I STILL HAVE QUESTIONS. So 1600 to 2000mg is recommended for average adults and that is 40-50mEq. Does that mean: 1600mg =40mEq and 2000mg=50mEq?? And you recommend 4,000 (100mEq?) for 25 y/o healthy males? A negative reply that you did not respond to said that 4,00omg was the RDA . Do you still stand that there is no RDA? Where did you find that? And who recommends the 1600-200omgs?? And what is “DV” on the OTC bottles? I have never understood why you can only buy 350mg = 3% DV over the counter bottles and you would have to take 33 pills to get 100% DV when multivitamins contains 100% of all other vitamins and minerals mostlly. The pharmacist I asked said most people got enough in their diet and warned that you could cause heart beat problems by taking too much. But as I understood you, only the Rx K Chloride could be toxic or cause heart to stop! Correct? I have had multiple ankle sprains and actually broke the distal end of my fibula off 2 years ago. I have cramps in my feet severely at night and take Magnesium and calcium and tonic water and leg cramp OTC with quinine and have started taking 10mEq K Chloride. I eat spinach or a banana almost daily. Do I need to take more K? I do have a heart murmur occasionally.
What was the reply about that stated not to take more than 2 tabs as it would rot our insides? Can you respond Please??

Reply

Ursula Noble December 10, 2014 at 10:11 pm

Hi Stephen, I just came across your site and jumped right in to discussions on potassium supplementation. I will explore your site as it sounds very interesting and I am looking for dietary tips. would you be able to elaborate on people who have certain conditions that may muck around with potassium levels , especially kidney problems? I am experiencing pain that feels like enlargement of the right kidney (2 previous episodes of stones) for a few months now and I have developed very severe edema in the legs/ankles/feet. I have been supplementing methyl B12 on and off for a few months also. (that question led me to your site). Drinking coconut water and coconut milk has reduced the swelling quite a bit but now I am feeling terribly achy all over? which kidney problems can cause potassium depletion? thank you.

Reply

Stephen December 15, 2014 at 3:31 am

Hi Ursula, have you been to a clinic to have some blood work done? Also, flank/back pain can be tricky to diagnose, you may be in need of a renal ultrasound. I could write a 5 page dissertation covering potassium and renal disease and still miss a lot. If you have concerns, in this case, I would highly recommend you see your primary care provider ASAP.

- Stephen

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