Guest Post: PMDD and Potassium

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Medical disclaimer: I am not a healthcare professional. This article is for informational purposes only and should not be used as a substitute for professional medical advice, diagnosis or treatment. Never take potassium supplements without first checking with your doctor. Always inform your doctor about all OTC and prescription medications you are taking because some can cause potassium levels to increase to dangerous levels. If you begin any new medications while on potassium, check with your doctor to make sure continuing potassium is safe. I do not know if potassium will help everyone with PMS/PMDD. Never disregard medical advice or delay any treatment because of anything you read here. - Beckie Takacs

Dear Reader - If after reading my blog you decide to try potassium, please email me first for the updated and detailed protocol at BeckieTakacs@gmail.com.

In 1977, when I was 23, I developed a severe case of PMDD immediately following injections of prescription steroids. Ten days before my period I would suddenly become very exhausted, depressed and irritable. I had heart palpitations, muscle weakness, frequent headaches, abdominal bloating and weight gain. I became an absolute basket case. Losing control of my emotions was a common occurrence.

Overwhelming anger and rage would suddenly envelop me for no apparent reason. Getting out of bed and dragging myself to school was about all I could manage and this greatly impacted on my studies. Then, just as quickly as my PMDD began, it would end, a few hours prior to my period. Once again I was happy and healthy, vowing never to feel that way again.

Over the next four years, I saw four doctors and none of them had an answer or even a diagnosis. I had told each of them about the steroid injections that started everything, but no one was interested. I would have blood work done and everything was always in the normal range. I finally decided to research the drug myself (I have a science background) because I was afraid that whatever condition this was might eventually be fatal. It didn’t take long to discover that one of its numerous side effects was a potassium deficiency.

I had just gotten married a few months earlier and moved to Zurich so I went to the University of Zurich’s Pharmacology Department library and read everything I could on potassium. Potassium deficiency symptoms included fatigue, depression, irritability, heart irregularities, muscle weakness, anger, etc. – all the symptoms I had during my luteal phase. In addition, potassium was critical to maintaining proper fluid balance. A potassium deficiency could not be corrected by diet alone because of the acid-base imbalance that often accompanies its loss and therefore, supplements had to be used. Eating a potassium-rich diet, which I had always done, did not help my symptoms.

I knew taking potassium supplements was medically safe for me, so I began taking them every day beginning very early in my cycle. To my surprise, my stamina and energy level dramatically improved. This occurred within the first week of beginning the potassium when it was still my non-symptom follicular phase. In retrospect, I had become so accustomed to my stamina being low all the time that it seemed normal compared to the extreme fatigue I experienced during my PMDD time. Over the next three months, my symptoms gradually decreased until I was completely free of PMDD.

In 1977, premenstrual syndrome was not widely known and the PMDD classification for very severe PMS was still many years away. It wasn’t until 1983 that I first learned about PMS and was able to put a name to the condition I’d had. Later that year, two other women I knew who had PMS/PMDD took potassium (according to a specific protocol I had worked out by trial and error) and it also worked for them. Basically, the protocol involves taking an effective dose of potassium every day until symptoms are gone, which usually means through the fourth cycle. For most women, 600 mgs/day (only 13% of the RDA) was sufficient. For some reason, taking phosphorus-free calcium as a supplement (usually as the carbonate, hydroxide, lactate, gluconate, citrate, ascorbate including Ester-C) or in calcium-fortified foods and drinks prevents the potassium from working. Once the symptoms are gone, phosphorus-free calcium doesn’t cause an issue and can be used whether you choose to continue taking potassium or not. Natural dietary sources of calcium, such as dairy, are fine.

I brought these results to the attention of a doctor at the University of Utah Medical Center and from 1984-5, organized and conducted a small pilot study for his observation. Seven women with PMDD followed the potassium protocol and all found their symptoms decreasing over the course of three cycles until they were free of symptoms. No longer did they have to be careful managing their stress levels or diet in order for their PMDD not to return. It was simply gone. In addition, most noticed their overall health and energy levels improve. Unfortunately, there was no funding to carry out the properly controlled medical study the doctor and I had hoped to do, so that ended things at the time. Later, I wrote up the results of the study and the protocol and published it in a journal so that the information could be easily accessed. The link to the article is: http://orthomolecular.org/library/jom/1998/articles/1998-v13n04-p215.shtml. Recently, the results were independently replicated in a pilot study of 11 women conducted by Dr. B. Okeahialam. (1)

I don't believe PMS/PMDD is necessarily caused by a severe potassium deficiency, but a low to moderate one that might not be picked up in a routine serum potassium test. This test only measures the small extracellular fraction of potassium present in the blood serum and is not always an accurate indicator of total body potassium content. Only one of the 11 women participating in Dr. Okeahialam’s pilot study had a serum potassium level below normal. Some labs now test intracellular potassium levels by measuring its concentration inside red blood cells (RBC), giving a more accurate picture of total body potassium content. A pilot study in the UK found women with PMS/PMDD generally had RBC potassium levels at the low end of normal.(2) Surprisingly, it is not the case that the worse the PMS/PMDD symptoms, the greater the amount of potassium needed. It seems to me as if there is an optimal amount of potassium that is required very early in the follicular phase in order to have a healthy menstrual cycle. Other factors that go “wrong” as a result of the low potassium are responsible for the actual symptoms and severity and would vary with the individual.

So how could just one nutrient be the root cause of PMS/PMDD, a condition with so many different symptoms? Potassium is important in many different biological processes including protein synthesis and folding, maintenance of the biological clock and biorhythms(3), mitochondrial function, glycogen storage, insulin release, nerve conduction, apoptosis, gene expression, cell division, acid-base balance, cell volume control, etc. The transcription of many genes have been identified as being sensitive to the ratio of intracellular sodium to potassium concentrations.(4) Potassium can be thought of as an antioxidant(5) and a nutrient that promotes anti-inflammatory processes.(6, 7) The typical western diet of high sodium/low potassium intake is associated with high blood pressure and increased risk of stroke.(8) A website that discusses the importance of potassium is “High Potassium Foods” and has some interesting articles.(9)

Potassium is the most abundant intracellular cation in our bodies. Its concentration within cells is about 30 times greater than that of the extracellular fluid. This gradient is maintained by the sodium/potassium ATPase pump which requires magnesium. This enzyme pumps three sodium ions out of the cell for every two potassium ions in and the resulting distribution of sodium and potassium is essential for normal cell function. The ratio of intracellular to extracellular potassium concentrations determines cardiovascular and neuromuscular excitability, so even though the total extracellular fluid content is less than 2% of the total body content, it is very important it be tightly regulated. In addition to its role in maintaining the ion gradients, the sodium/potassium pump can also form signaling complexes and regulate intracellular calcium.(10) The pump activity is lower during the luteal phase of women with PMS/PMDD.(11)

The kidneys are the major regulator of long-term potassium homeostasis and serum potassium. However, in the short term, which occurs when a high potassium meal is eaten, potassium sensors in the gut trigger the kidneys to increase the rate of potassium excretion. In addition, insulin quickly stimulates potassium uptake into skeletal muscle and liver cells. These two actions prevent an excessive rise of potassium in the blood serum. However, when an increase in potassium consumption increases serum potassium concentrations sufficiently, the adrenal hormone aldosterone is released and acts on the kidneys to increase potassium excretion. Through these mechanisms, a healthy person not taking a potassium-sparing drug can safely eat a wide variety of foods containing high amounts of potassium.(12) The aldosterone receptor blockers, spironolactone, and Yaz, are potassium-sparing drugs. They allow the total body potassium content to increase and have been shown to be helpful for both the physical and emotional symptoms of PMS/PMDD.(13)

Aside from diseases that interfere with the handling of potassium, such as kidney and adrenal disease, a potassium deficiency can occur from a number of situations. These include illness (especially those involving vomiting and diarrhea), stress of surgery, high protein diets, the overuse of laxatives, diuretics, ingestion of baking soda (bicarbonate) which is sometimes used for indigestion and UTIs, alcoholism, severe magnesium deficiency, eating disorders such as anorexia and bulimia, certain medications and over time, a low potassium diet. Also, the loss of chloride that occurs from profuse sweating and vomiting can eventually lead to potassium deficiency. Pregnancy greatly increases the need for potassium and your body does retain more at this time. The average intake in women 20+ years and older is only 2408 mgs/day. The RDA for potassium is 4700 mgs/day and it is estimated that less than 1% of women get this amount in their diet.(14) Breastfeeding women require 5100 mgs/day.(15) As you can see, the 600 mgs/day of potassium that is sufficient for most women to use for PMS/PMDD is not much when compared to the RDA.

Those are my experiences with potassium and PMS/PMDD and my thoughts about a connection between them. It is my hope that someday, someone might be interested in collaborating on a rigorous, scientific double-blind placebo-controlled study.

For an updated protocol or any questions, you can email me at BeckieTakacs@gmail.com


References

(1) https://www.jscimedcentral.com/Obstetrics/obstetrics-5-1101.pdf Okeahialam BN (2017) Potassium Treatment for Premenstrual Syndrome Med J Obstet Gynecol 5(2): 1101

(2) http://www.biolab.co.uk/index.php/cmsid__biolab_abstracts/rssid__193 Stewart A, Howard, Magnesium and Potassium Deficiencies in Women with Premenstrual Syndrome, Mag. Bull. 1986; 8: 314-316.

(3) http://www.cell.com/cell/fulltext/S0092-8674(15)00913-7 Flourakis, Matthieu, et al, A Conserved Bicycle Model for Circadian Clock Control of Membrane Excitability, Cell 162(4), p836-848, 13 Aug 2015.

(4) http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0038032 Koltsova, Svetlana V, et al, Ubiquitous [Na+]i/[K+]i-Sensitive Transcriptome in Mammalian Cells: Evidence for Ca2+i-Independent Excitation-Transcription Coupling, PLoS One Published: May 29, 2012

(5) http://hyper.ahajournals.org/content/hypertensionaha/48/2/225.full.pdf Matsui, Hiromitsu, et al, Protective Effect of Potassium Against the Hypertensive Cardiac Dysfunction Association With Reactive Oxygen Species Reduction Hypertension 2006; 48:225-231.

(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382086/ Sun, Peng, et al, Cyp2c44 Epoxygenase Is Essential for Preventing the Renal Sodium Absorption During Increasing Dietary Potassium Intake, Hypertension 2012; 59:339-347

(7) https://www.hindawi.com/journals/ijvm/2012/605101/ Thompson, Scott J, et al Anti-Inflammatory Effects of Epoxyeicosatrienoic Acids, International Journal of Vascular Medicine vol. 2012, Article ID 605101, 7 pages

(10) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375021/ Tian, Hang and Xie, Zi-Jian. The Na/K-ATPase and Calcium Signaling Microdomains, Physiology (Bethesda) 2008 Aug 23; 206-211

(11) http://www.clinsci.org/content/ppclinsci/82/s26/28P.4.full.pdf #104 RL Ozin, et.al., Changes in sodium and water transport in Premenstrual Syndrome, J Clin Sci 1992 82:28 #104

(12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455213/ Palmer, Biff F, Regulation of Potassium Homeostasis, Clin J Am Soc Nephrol 2015 June 5: 1050-1060.

(13) https://www.ncbi.nlm.nih.gov/pubmed/8533564 Wang, M, et al, Treatment of Premenstrual Syndrome by spironolactone: a double-blind, placebo-controlled study, Acta Obstet Gynecol Scand 1995 Nov; 74(18) 803-8

(14) https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/10_potassium_intake_0910.pdf USDA Potassium Intake of the U.S. Population “What We Eat in America”, NHANES (2009-2010)

Beckie Takacs