Making Sense of Keto Electrolytes: The Unedited 2017 Original
This is the original camera file of my electrolytes explainer. I recorded it on 2017-08-24 and it went up on YouTube the next day, about fifteen seconds shorter. The content is the same. The full write-up, including what the trials say about light salt and how much sodium, is Keto Electrolytes Made Simple. This post covers two things that one didn't: what I said about kidneys, and what I reached for when I was actually sick in 2020.
In this recording
- [0:10] Name the four electrolytes (sodium, potassium, magnesium, calcium) and they get easier to find.
- [0:48] Potassium is the keto problem, because potatoes are its usual source. Calcium and magnesium come from leafy greens.
- [1:29] Pickle juice has all four. Supplements can affect the kidneys and then the heart, and sodium and potassium work as a ratio.
- [2:09] Signs to watch: headaches, cramping, irritability, low energy. Don't start supplements before involving your doctor.
- [2:42] A daily multivitamin and light salt (part potassium chloride) as backstops. Greens first.
- [3:17] Electrolyte drinks hold less than people think.
- [3:46] A rehydration drink can help acutely with cramps. And you can cause your own keto flu by treating lettuce like the enemy.
- [4:21] Involve your doctor if you've had kidney or heart problems. Every trip to the bathroom passes salts.
- [5:00] Peeing clear means slow down on the water. Pale yellow plus symptoms means check your greens and salt.
- [6:13] Swollen hands or feet mean too much salt. Most people with pre-diabetes or type 2 have some kidney impairment, I said, so bring it up with your doctor.
- [7:15] Recap: salt your food, consider light salt, eat leafy greens.
The claim worth unpacking: kidneys and blood sugar
At [6:13] I said most people with pre-diabetes or type 2 diabetes have some kidney impairment. I can't back that number with the evidence collected for this site, so take it as my 2017 impression, not a statistic.
The advice it led to does hold. The WHO suggests potassium-containing salt substitutes in place of regular salt, except for people at risk of hyperkalaemia, meaning too much potassium in the blood (WHO sodium reduction fact sheet). If you have diabetes, kidney disease or heart trouble, or you take blood-pressure pills, talk to your doctor before light salt or potassium supplements. That includes a doctor who has never told you your kidneys are a problem.
For scale, the potassium reference intakes are 2,600 mg a day for women and 3,400 mg for men, and NASEM set no chronic-disease risk reduction intake for potassium (NASEM, 2019). For magnesium, the 350 mg a day upper limit covers supplements only (IOM, 1997). That's the logic behind greens first, pills second.
Then vs now: sick on keto in 2020
In a March 2020 Live I was sick myself, and I came back to this subject. I said keto eaters get less sodium and potassium because the salty, starchy foods are gone, and that fever and dehydration add to the risk of cramps. I named broth and a potassium citrate drink powder as what I was using. Its advantage when you might throw up is that it absorbs quickly (live NILS3514). So the 2017 "greens and salt first" became "greens and salt, plus something fast when you're ill." The doctor caveat for kidney and heart patients applies to that powder too.
One thing that's reassuring for beginners: when researchers analysed online posts about "keto flu", the symptoms clustered in the first weeks and were mostly described as passing (Bostock et al., 2020). That fits what I said here. Most of it is fixable with salt, greens and not over-drinking.
Key points
- Four electrolytes: sodium, potassium, magnesium, calcium. Food sources first.
- Clear urine means drink less, and swelling means less salt.
- Kidney disease, heart trouble, diabetes or blood-pressure medication: ask your doctor before light salt or potassium pills.
- When sick, broth and a fast-absorbing potassium drink were my 2020 additions.
- Keto flu symptoms are usually early and short-lived.