G'day Ataraxia52 (Mike) (and all)

I think that in an indirect fashion I may be able to help answer your question.

Despite my formal training in physics, many decades of studying nutrition, diet and exercise, and putting my reading and thinking into practise, some months back I was disconcerted to discover, yet again, how little I knew.

Background to this revelation

My wife had been on a 1200 Cal (kilocalorie) a day low carb diet for about three months, monitoring her intake using a set of kitchen scales, measuring cups and Fitness Pal. Much to her bemusement and frustration, her body mass (weight) was unchanged.

About five years ago, my mother was diagnosed with pre-diabetes and then, a year later, with full-blown T2DM (type 2 diabetes mellitus). She doesn't have a computer or access to the internet so I had been trying to help her from the other side of the world.

I'd bought my mother a number of books on diabetes including a copy of Richard Bernstein's classic about managing diabetes, and I'd bought her a number of different glucose monitors plus their proprietary strips. My father had died from pancreatic cancer and, during his last months, I had done much research using PubMed into pancreatic cancer and the role of the pancreas. I thought I knew a fair bit about how the pancreas does (or doesn't) work.

I'd been following the results of the Newcastle Study, plus those diabetics who had reduced their calorific intake to 600 Cals (or 800 Cals) a day. Most were also on low carb, some on very low carb, some on ketogenic diets. The aim was to strip fat from the liver followed by stripping fat from the pancreas. All self-monitored their blood sugar. Some had noticed significant improvements in their blood sugar after just one week.

I suggested to my wife that, as an experiment, she and I followed a Very Low Calory (and Very Low Carb) VLC/VLC diet of 800 Cals/day for one week. We kept it up for nine days. Then we increased our intake to 1000 Cals/day for a fortnight. Then we increased back to 1200 Cals/day. At the same time, my wife rode her bike two or three times a week after dark for about half an hour. The result was that about a month after we had begun the 800 Cal/day diet my wife had lost about 3 kg (6.5 lb) which made her quite happy.

A month later, while at work, my wife had what appeared to be a stroke or TIA (transient ischaemic attack). The paramedics duly arrived, checked her out and said they were confident she had not had a stroke or TIA but they could take her to the local hospital to be sure if she wanted to. She saw her GP the next day, who, after listening to my wife, put the episode down to an anxiety attack brought on by her being observed that afternoon in her job as a classroom teacher by her line manager, one of the school’s two deputy principals.

Back to the present

This is going on too long. Hence, I'd better cut to the chase. I had already been concerned about the potential side effects of a VLC diet, especially the effects of low potassium in the diet. I discovered that, in 2004, the US Institute of Medicine (IOM) had concluded that an Adequate Intake of potassium for North American adults is 4.7 g of elemental potassium a day [1]. Further research indicated that less than 10% of North Americans met this figure. The IOM also recommended that the potassium be taken in the form of the organic salts of potassium found in fruits and vegetables, because of the organic salts' buffering effects on the blood, rather than in the form of potassium chloride found in red meat, white meat, fowls and fish. The main organic salt of potassium found in fruit is potassium citrate. Potassium bitartrate is another. Potassium bitartrate is readily found in most households under the name of Cream of Tartar.

Cream of Tartar (Potassium bitartrate)

One level 5 ml teaspoon of Cream of Tartar powder contains about 5 g of potassium bitartrate which contains about 1 g of potassium. To get all your 4.7 g/day of potassium recommended by the IOM, you would need to consume roughly five standard 5 ml teaspoons of Cream of Tartar per day. This is a fair bit, and in my view, unrealistic day in day out. I've experimented and found that one 5ml teaspoon of Cream of Tartar dissolves quite well in a small amount (about 20 ml) of orange and mango juice, which of course contains a decent amount of citrate.

From time to time, my wife and I take a spoon of Cream of Tartar in a small amount of orange/mango juice, but not every day, only when we remember, which isn't all that often. Moreover, one teaspoon contains only about 1 g of potassium, which is well short of the 4.7 g AI.

Conclusion

In conclusion, if you follow the recommendations of the IOM, you should be trying to increase your total potassium intake to 4.7 g per day, and it's better to get your potassium as an organic salt such as potassium citrate rather than as an inorganic salt such as potassium chloride.

Richard M

1) ‘Dietary reference intakes for water, potassium, sodium, chloride, and sulfate’; IOM; first published 11 Feb 2004; http://www.iom.edu/Reports/2004/Die...nd-Sulfate.aspx