Low serum potassium in COVID-19 and thoughts on interventions:
In a study of 175 COVID-positive patients in collaboration with Wenzhou Hospital in China, nearly all were identified as having hypokalemia (low serum potassium), likely due to the mechanisms of COVID-19 on ACE2 receptors and the renin-angiotensin system. It may be that COVID creates a hyperaldosteronism kind of imbalance, causing sodium sparing and potassium wasting. Those that already had low potassium before COVID did worse. Those with low serum potassium that responded well to potassium ion supplements were reported to do better.
It was also noted that the resolution of urinary K+ (potassium) losses may be a sensitive biomarker for identifying an improvement in effects on the renin-angiotensin system.
Interestingly, not only might the pathophysiology of COVID induce potassium wasting via ACE2 induced hyperaldosteronism, it turns out that low intracellular potassium triggers the NLRP3 inflammasome. NLRP3 activation is fundamental to the cytokine storm induced by COVID.
The very simple take-home is that we all need to be ingesting loads of potassium-containing foods as a part of our COVID prevention protocol. With active COVID infection, some of us (perhaps most of us?) likely need supplementation.
Potassium deficiency is extremely common (in the US, we ingest about 7% of required potassium, and close to 300% of sodium). Humans are the only mammals to flip the intake of sodium and potassium; favoring much higher sodium. Thus, we are strongly recommending everyone think about dietary potassium as an essential COVID preventative. If possible, consider getting tested. We like serum potassium to be between 4-5 mEq/L.
All of us can safely eat lots of potassium from foods! Vegetables – Asparagus, artichokes, broccoli, cauliflower, dark leafy greens (e.g. collards, kale, mustard greens, spinach, swiss chard, turnip greens), celery, green beans, mushrooms, parsnips, potatoes, pumpkin, sweet potatoes, tomatoes, winter squash. Fruits – Avocado, banana, cantaloupe, cherries, figs, green kiwi, orange prunes. Legumes – Lentils, lima beans, pinto beans, red kidney beans, white beans. Soy products (fermented) – Miso, natto, tamari, tempeh.
Those with high blood pressure may need to consider supplementing above 99mg potassium (the typical limit on over-the-counter potassium supplements), BUT you’ll want to get physician approval first, especially if you are being managed on antihypertensives. Following serum potassium levels might also be a very smart choice for some.