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Stewie and other docs: potassium with ACEi/ARB

MKSuccess500

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Hey guys, just curious if anyone is aware of any issues with taking a natural diuretic with high potassium while on an ace inhibitor or angiotensin receptor blocker.

Dandelion extract (not just the root) had previously been able to shed 3-5lb of water off of me and is great for vacations but I've recently heard of some issues with athletes going into cardiac arrest from high potassium intakes https://www.ncbi.nlm.nih.gov/pubmed/21075579 and it's theorized that dandelion extract's diuretic effect is due to it's high potassium content.

For those on aces and arbs and I'm wondering if this could really be a concern, especially if on vacation when one may be eating a lot more than normal and already screwing around with electrolyte levels
 

IsaacHaze1

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Hey guys, just curious if anyone is aware of any issues with taking a natural diuretic with high potassium while on an ace inhibitor or angiotensin receptor blocker.

Dandelion extract (not just the root) had previously been able to shed 3-5lb of water off of me and is great for vacations but I've recently heard of some issues with athletes going into cardiac arrest from high potassium intakes https://www.ncbi.nlm.nih.gov/pubmed/21075579 and it's theorized that dandelion extract's diuretic effect is due to it's high potassium content.

For those on aces and arbs and I'm wondering if this could really be a concern, especially if on vacation when one may be eating a lot more than normal and already screwing around with electrolyte levels

granted, I had a kidney transplant, but my ACE inhibitor sent my potassium levels very high.
 

Phidias

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I've been on Ramipril (ACE inhibitor) for 14 years now, and YES, I can vouch it will skyrocket your potassium levels, especially if your sodium intake is low or/and if you eat K+ rich foods.

Anecdotal, but I remember getting very sick one year (violent case of stomach flu that made me throw up uninterruptedly for two days straight), to the point I ended up in the hospital for people around me started to really get worried (I was too :eek:)... well, after they draw my blood upon arrival (keep in mind I hadn't eaten anything for the last two days, just sipping on water), docs came back all freaked out, asking if I had an explanation for way out of range (sky high) potassium in spite of not having food... all I could think of was Ramipril, and in fact they eventually got to conclusion it was the culprit.

From this day I just kept on slowly decreasing my daily dose of 5mg to finally settle at 1.25mg now, and truth is I feel much better. But even on that low of a dose I have to pay attention to both eat salty enough and limit potassium intake, otherwise I get extremely tired fast, experiencing bad cases of low blood pressure.

Same happens if I supplement too much with magnesium too... it literally kills me, and I can feel right away something is not going well with my heart. Sodium and sodium bicarbonates are like life savers to me... :cool:

People always get scared (righfully) of the dangers of high blood pressure, but low BP is clearly no joke either... and to avoid it, you better not mess too much with potassium.

It's btw the main reason why so many competitors collapse on stage... :(
 
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Stewie

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I would advise not to take any extra potassium and or K+ sparing natural diuretic if on an ACEi or an ARB.

Some individuals can get by using natural K+ sparing natural diuretics, this would be independent of one's renal potassium handling.

At any rate, I'd suggest not using them.
 
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[email protected]

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i am using candesartan and 12,5mg hctz. Potassium was/is on the higher side esp if i am low on salt.
Included pink himalaya salt into my fasting period made it much better
 

MKSuccess500

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Thank you all for the replies

I would advise not to take any extra potassium and or K+ sparing natural diuretic if on an ACEi or an ARB.

Some individuals can get by using natural K+ sparing natural diuretics, this would be independent of one's renal potassium handling.

At any rate, I'd suggest not using them.

Interesting. In theory I suppose the thiazide diuretics and loop diuretics would be much safer for someone on an ACEi or ARB?

For the record here are the current electrolyte values
Urea Nitrogen (BUN): 24 (7-25 mg/dL)
Creatinine: 1.21 (0.6-1.35 mg/dL)
eGFR Non-Afr Am.: 82 (> or = 60 mL/min/1.73m2)
eGFR Afr Am.: 95 (> or = 60 mL/min/1.73m2)
Sodium: 139 (135-146 mmol/L)
Potassium: 4.1 (3.5-5.3 mmol/L)
Chloride: 105 (98-110 mmol/L)
Carbon Dioxide: 27 (20-31 mmol/L)
Calcium: 9.2 (8.9-10.4 mg/dL)

So it seems like everything is perfect

So if someone is taking an ACEi/ARB it's actually more important they take in adequate sodium, despite the recommendations to lower sodium when there are heart concerns?
 

nothuman

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I started using 5mg Nebivolol recently and just scored a 4.2 potassium serum so no issues for me
 

MKSuccess500

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I started using 5mg Nebivolol recently and just scored a 4.2 potassium serum so no issues for me

I'm not concerned about my current potassium levels, they're the same as they've always been. However, my concern would be that taking a natural diuretic like dandelion extract would cause me problems.

I really like dandelion extract but it apparently has it's diuretic effect because of its high potassium content.

Stewie or others who know, how would an ACEi/ARB even cause a problem with this if one has normal potassium levels while taking them? Do they prevent normal flushing out of potassium so if someone takes high amounts of potassium (like in a natural diuretic) it still causes an issue even if there "before" levels were normal?
 

IsaacHaze1

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I'm not concerned about my current potassium levels, they're the same as they've always been. However, my concern would be that taking a natural diuretic like dandelion extract would cause me problems.

I really like dandelion extract but it apparently has it's diuretic effect because of its high potassium content.

Stewie or others who know, how would an ACEi/ARB even cause a problem with this if one has normal potassium levels while taking them? Do they prevent normal flushing out of potassium so if someone takes high amounts of potassium (like in a natural diuretic) it still causes an issue even if there "before" levels were normal?

They do alter the way the kidney filters potassium. I couldn't quantify to what degree.
 

Elvia1023

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I've been on Ramipril (ACE inhibitor) for 14 years now, and YES, I can vouch it will skyrocket your potassium levels, especially if your sodium intake is low or/and if you eat K+ rich foods.

Anecdotal, but I remember getting very sick one year (violent case of stomach flu that made me throw up uninterruptedly for two days straight), to the point I ended up in the hospital for people around me started to really get worried (I was too :eek:)... well, after they draw my blood upon arrival (keep in mind I hadn't eaten anything for the last two days, just sipping on water), docs came back all freaked out, asking if I had an explanation for way out of range (sky high) potassium in spite of not having food... all I could think of was Ramipril, and in fact they eventually got to conclusion it was the culprit.

From this day I just kept on slowly decreasing my daily dose of 5mg to finally settle at 1.25mg now, and truth is I feel much better. But even on that low of a dose I have to pay attention to both eat salty enough and limit potassium intake, otherwise I get extremely tired fast, experiencing bad cases of low blood pressure.

Same happens if I supplement too much with magnesium too... it literally kills me, and I can feel right away something is not going well with my heart. Sodium and sodium bicarbonates are like life savers to me... :cool:

People always get scared (righfully) of the dangers of high blood pressure, but low BP is clearly no joke either... and to avoid it, you better not mess too much with potassium.

It's btw the main reason why so many competitors collapse on stage... :(

You know I told you I had been feeling crap recently which is very rare for me. I figured it was merely fatigue from MK-677 but it didn't go away when I dropped it. Anyway my 2nd thought was telmisartan as I have started it fairly recently. It's a different class of drug to yours but has similar effects and can raise potassium etc. I am going to drop it and see how I feel. If it is the telmisartan I will just go back to using carditone for my bp.
 
D

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You know I told you I had been feeling crap recently which is very rare for me. I figured it was merely fatigue from MK-677 but it didn't go away when I dropped it. Anyway my 2nd thought was telmisartan as I have started it fairly recently. It's a different class of drug to yours but has similar effects and can raise potassium etc. I am going to drop it and see how I feel. If it is the telmisartan I will just go back to using carditone for my bp.

How much Telmisartan are you taking? I'm on 80mg Valsartan per day and feel normal on it, and potassium levels are normal. What do you mean by "feeling crap"?
 

Phidias

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You know I told you I had been feeling crap recently which is very rare for me. I figured it was merely fatigue from MK-677 but it didn't go away when I dropped it. Anyway my 2nd thought was telmisartan as I have started it fairly recently. It's a different class of drug to yours but has similar effects and can raise potassium etc. I am going to drop it and see how I feel. If it is the telmisartan I will just go back to using carditone for my bp.

YES, Telmisartan might very well be the culprit in your case... though the initial fatigue can be normal and should logically go away or at least progressively decrease over time once your body gets adjusted to it, it might also not be the best BP med suited to YOUR body... curious to see if the situation improves once you stop it... :)

Anyways, as a matter of fact, all BP meds will to some degree affect your energy... the trick, if one really needs to be on such class of drugs, is to find the right one at the right dosage.
 

MKSuccess500

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Anyways, as a matter of fact, all BP meds will to some degree affect your energy... the trick, if one really needs to be on such class of drugs, is to find the right one at the right dosage.

What makes you say that? Why would that be?
 

rmtt

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What makes you say that? Why would that be?
Blood-pressure medications can slow down the pumping action of the heart as well as depress the entire central nervous system, or, in the case of diuretics (Which some BP medicines have in them), deplete electrolytes that the body needs.

As the volume of blood that is being moved around the body drops due to BP medication, the body reacts by producing less energy.

Most people adjust over time and feel better....but it's like getting used to a new (norm) for the body.

At least that's the explanation I got when my dad had heart surgery and was put on blood pressure meds.

He was waking around so long with an elevated blood pressure that he became used to feeling that way.

On the meds...he was extremely tired. After awhile....he adjusted to it and started doing better.

Sent from my LG-H871 using Tapatalk
 

heavyhitter

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I have noticed some extra cramping the last couple months or so. Wondering if maybe its the telmisartan now?
 
D

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Blood-pressure medications can slow down the pumping action of the heart as well as depress the entire central nervous system, or, in the case of diuretics (Which some BP medicines have in them), deplete electrolytes that the body needs.

As the volume of blood that is being moved around the body drops due to BP medication, the body reacts by producing less energy.

Most people adjust over time and feel better....but it's like getting used to a new (norm) for the body.

At least that's the explanation I got when my dad had heart surgery and was put on blood pressure meds.

He was waking around so long with an elevated blood pressure that he became used to feeling that way.

On the meds...he was extremely tired. After awhile....he adjusted to it and started doing better.

Sent from my LG-H871 using Tapatalk

This makes me wonder about these medications for life extension purposes. Often times people talk about an organism having a certain number of heart beats (roughly) and that the slower paced animals and those with slower metabolisms live longer. Additionally, life extension through caloric restriction seems to work by decreasing inflammation, cell turnover, etc...everything is somewhat slowed down.

If these medications are lowering blood pressure, lowering heart rate, decreasing CNS stimulation, etc...I wonder if someone taking them for most of their lifetime would tend to have a longer life compared to say a twin who did not take them, even in the absence of severe hypertension or cardiac issues.

My valsartan currently has my HR a bit too low (90/60) and my RHR has been 38-46 lately...but I am in a severe deficit so I'm hoping it doesn't stay that low.
 

bieberhole69

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From a pharmaceutical perspective--I would be worried about anything causing elevated potassium while on an ACEI (it's specifically on the drug label so that should key you in to how serious it is); however--heart failure patients are regularly on them in addition to potassium sparing diuretics.

With that being said, their bloodwork is also routinely closely monitored. I think if you're closely monitoring your bloodwork as well as signs and symptoms of high potassium (numbness / tingling, nausea and vomiting, shortness of breath, etc) then it might be OK to proceed.

Emphasis on the CLOSELY monitoring part.

At the same time, HCTZ is dirt cheap and wouldn't be an issue as it's routinely found in combination with ACEIs. That would, by far, be the superior option.

Edit: to those wondering about being tired etc...this is normal when first starting a new BP drug, as you're now "hypotensive" compared to YOUR normal. However, it should wear off in a few weeks--if it hasn't, I'd talk to my Dr. about it.
 
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rmtt

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This makes me wonder about these medications for life extension purposes. Often times people talk about an organism having a certain number of heart beats (roughly) and that the slower paced animals and those with slower metabolisms live longer. Additionally, life extension through caloric restriction seems to work by decreasing inflammation, cell turnover, etc...everything is somewhat slowed down.

If these medications are lowering blood pressure, lowering heart rate, decreasing CNS stimulation, etc...I wonder if someone taking them for most of their lifetime would tend to have a longer life compared to say a twin who did not take them, even in the absence of severe hypertension or cardiac issues.

My valsartan currently has my HR a bit too low (90/60) and my RHR has been 38-46 lately...but I am in a severe deficit so I'm hoping it doesn't stay that low.

Its a valid hypothesis. I have read a lot about the heart having a finite number of contractions on average during a healthy person's lifestyle.

I know first hand from caloric restriction that my bloodwork improves consistently...and I've tested that in the past using foods that are considered not really healthy choices.

It's odd that low calorie diets made up of some bad food shows a marked improvement over higher calories of clean food.....in my case anyway.

But that could be the merits of fasting intermittently affecting that.

I'm taking Carditone even though I don't have high BP.

I typically stay in the 105/65 range or thereabouts....and a resting pulse rate of between 55-60.

Sent from my LG-H871 using Tapatalk
 

nothuman

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Its a valid hypothesis. I have read a lot about the heart having a finite number of contractions on average during a healthy person's lifestyle.

I know first hand from caloric restriction that my bloodwork improves consistently...and I've tested that in the past using foods that are considered not really healthy choices.

It's odd that low calorie diets made up of some bad food shows a marked improvement over higher calories of clean food.....in my case anyway.

But that could be the merits of fasting intermittently affecting that.

I'm taking Carditone even though I don't have high BP.

I typically stay in the 105/65 range or thereabouts....and a resting pulse rate of between 55-60.

Sent from my LG-H871 using Tapatalk

The finite number of contractions for the heart thing isn't true. That's like saying our heart is like a battery. HIIT cardio wouldn't be such a healthy thing to do if that were true.

I've also seen low calorie diets make the most improvements in health. It's just unrealistic for me to remain on a caloric restriction every day the rest of my life though, so I don't see the harm in taking one of these BP meds as long as it's well studied and considered safe. I feel more comfortable without high BP and a low resting heart rate.
 

MKSuccess500

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From a pharmaceutical perspective--I would be worried about anything causing elevated potassium while on an ACEI (it's specifically on the drug label so that should key you in to how serious it is); however--heart failure patients are regularly on them in addition to potassium sparing diuretics.

With that being said, their bloodwork is also routinely closely monitored. I think if you're closely monitoring your bloodwork as well as signs and symptoms of high potassium (numbness / tingling, nausea and vomiting, shortness of breath, etc) then it might be OK to proceed.

Emphasis on the CLOSELY monitoring part.

At the same time, HCTZ is dirt cheap and wouldn't be an issue as it's routinely found in combination with ACEIs. That would, by far, be the superior option.

Edit: to those wondering about being tired etc...this is normal when first starting a new BP drug, as you're now "hypotensive" compared to YOUR normal. However, it should wear off in a few weeks--if it hasn't, I'd talk to my Dr. about it.

I don't think I could get HCTZ anyway but ok I'll avoid the dandelion extract. I don't even know how much potassium is in it specifically but it seems it's theorized that the reason it causes diuresis is due to high potassium so it probably isn't worth risking.
 

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