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What Causes Hypokalemia

author avatar Dr. Eric Berg 08/31/2023

Have you ever heard of hypokalemia, or low potassium in the blood? Potassium is one of the most important minerals in the body. Unfortunately, it is really hard to get enough of it. We need a lot, and most people don't eat nearly enough vegetables to keep their levels in the normal range. And on top of that, there are several other things that can deplete your potassium levels, such as vomiting or medications. In this article, I'll discuss those top hypokalemia causes and share with you how to avoid this problem.

I will cover:

First, I'll explain what this condition is and why you might want to know about it.

Potassium periodic table of elements mineral information on wood board with reflection.

What is hypokalemia?

Hypokalemia is a condition where you have low potassium levels in your blood.

You may already know that you need a lot of potassium. Our bodies require a lot of potassium each and every day to stay healthy and keep things running smoothly. In fact, you need about 4,700 mg of it every single day.

When you aren't getting enough potassium, or you are losing too much of it due to various factors, you can end up with low potassium in your blood.

Unfortunately, hypokalemia is hard to detect. Most potassium in the body is found inside the cell. In fact, 98% of it is inside of your cells and not outside in the blood. So when a doctor does a blood test, it can be hard to really assess the true level of total body potassium.

By the time tests show that you have a potassium deficiency in your blood, you'll actually be very low in potassium overall. Blood tests won't show potassium deficiency unless it is really, really extreme.

So why is it important to avoid hypokalemia in the first place? Why do you want to keep potassium at healthy levels?

It turns out that potassium is a vital electrolyte. It allows your body to perform a large number of vital functions. And when you don't have enough of it, things can go wrong. Let's take a closer look at the roles it plays in the body.


What does potassium do in the body?

I consider potassium to be the #1 most important electrolyte. It is a mineral that helps conduct electricity in the body. And so it helps do a lot of things.

This mineral is the one we need the most of. It does so much to keep things running smoothly, from your digestion to your movement to your energy production.

In the body, potassium helps to:

  • Keep blood pressure healthy and low. Potassium lowers blood pressure while sodium increases it. We need enough potassium to keep our blood pressure in balance.
  • Allow your muscles to move. It is involved in muscle contraction and relaxation and is essential in how you move your body. And don't forget that your inner organs have muscles too, such as your stomach and intestines. So potassium helps things move smoothly in your organs, too.
  • Stabilize blood sugar. It helps to store blood sugar in the body, which helps keep it out of your blood. This allows it to help keep blood sugar low and stable.
  • Promote heart health. Potassium is the main electrolyte for heart function. The electrical system in your heart that keeps it beating on rhythm relies on potassium.
  • Give you energy and charges your cells. It is involved in providing energy to your cells. That is vital in keeping you functioning in top shape.
  • Make proteins. Potassium is involved in the process that makes proteins. Proteins are used to make up all the different parts of your body.
  • Relax the body. It helps promote rest and recovery. That allows you to refuel when you need it.

As you can see, potassium plays an essential role in a wide range of vital functions in the body. So when you don't have enough of it, many different things can go wrong. And you end up with a variety of symptoms.

Next, we will cover what happens when you have low potassium levels.


Potassium periodic table of elements mineral information on wood board with reflection.

Symptoms of hypokalemia

Potassium plays such an important role in so many different systems in the body. When you become potassium deficient, you can have many different symptoms.

These symptoms can affect you all over your body, from your gut to your heart to your legs.

The symptoms of hypokalemia include:

  • Fatigue
  • Leg cramps
  • Muscle weakness
  • Constipation
  • Arrhythmias
  • High blood pressure
  • Insomnia
  • Anxiety

Everything from your heartbeat to your energy levels can be affected by your potassium levels. You can learn more about the symptoms of hypokalemia in this video.

But what causes hypokalemia in the first place? Why might you not have enough of this important electrolyte? There are a number of reasons you can end up with low potassium.


Hypokalemia causes

Arrhythmia, muscle weakness, and other symptoms of hypokalemia can be pretty serious. In order to avoid this condition, it is important to know what brings it on.

From medications you might be taking to lifestyle habits, there are many different reasons you could be experiencing low potassium. These factors usually involve one of two things: 1) Not getting enough in the first place, or 2) Depleting your body of the stores it has.

Illustration of orange diuretic pill bottle and green diuretic medication box.

Below are the common causes of hypokalemia.

  1. Diuretics. Diuretic meds can keep potassium in the body low. The problem is that diuretics are used in order to lower blood pressure. But when they also lower potassium levels, this creates a problem. Your body needs potassium to maintain healthy blood pressure, so this creates a bad cycle.
  2. High cortisol levels. When you have high cortisol in the body, this will deplete potassium. Whether from stress or from taking drugs like steroids, high cortisol is not good.
  3. Diarrhea. You can lose a lot of potassium when you are having diarrhea. And that can bring on hypokalemia.
  4. Vomiting. As with diarrhea, vomiting can lead to excessive potassium excretion. It is a common cause of hypokalemia.
  5. Steroids. As mentioned above, high cortisol depletes potassium. And steroids boost cortisol levels. So when you are taking steroids, it can be really bad for potassium levels. The result is often hypokalemia.
  6. Diet. Many people are hypokalemic because they simply aren't getting enough of this mineral in their diets. If you aren't eating enough vegetables, you'll have a hard time getting the amount you need.
  7. The keto diet. When you first transition into the keto diet, you go through a period of time where your body needs to adapt. This is called keto-adaptation. It is a time when you can get symptoms like the keto flu, rashes, or headaches. These are usually caused by not enough potassium. Your body uses more potassium than normal during this transition phase, so you need more of it than usual. You can run low on potassium if you aren't adding in plenty of extra. That is why I recommend eating so many veggies.
  8. Diabetes. When you have high Fat Storing Hormone levels, that will deplete potassium levels. That happens with diabetes or pre-diabetes. And it will also block potassium from being able to go inside of your cells where it needs to go.
  9. Alkalosis. This refers to a condition of excessively alkaline blood. Blood is normally alkaline, but this occurs when it gets way too low. Alkalosis and hypokalemia go hand in hand. Almost every person who has one also has the other. The symptoms of these two conditions are also almost identical.
  10. Sugar and high fructose corn syrup. When you eat sugar, it will lead to hypokalemia because it depletes potassium levels. High fructose corn syrup, in particular, causes low potassium.

As you can see, there are many different factors that can bring on hypokalemia. You need to be careful of the medications you are taking, the way you are eating, and the lifestyle choices you are making if you want to maintain healthy potassium levels.

Remember, potassium is the #1 electrolyte in the body, and you need it to be healthy. So let's dive deeper into what you can do to prevent low potassium levels in the first place. Let's consider some of the important steps you can take to protect yourself.


Preventing low potassium

When it comes to keeping potassium at a healthy level, it really comes down to two major factors. Here are the two things you should be doing:

1. Consume more potassium

Up your potassium intake. This means eating a lot more healthy veggies. Green leafy vegetables are particularly great choices. Read more about some of the best sources you can add to your diet in the next section. Or, go here to learn more.

2. Do what you can to reduce the causes listed above

Take a look at the list of causes up above. Do any of the factors apply to you? Perhaps you take a diuretic or a steroid. Maybe you eat a lot of sugar or are under a lot of stress.

Consider what you might be able to change to reduce these factors in your life. For example, maybe you can work on getting your blood pressure under control. If you do that, you could possibly come off of your diuretic which will help boost potassium.

A woman practicing yoga meditation on a purple yoga mat in a park, hands on knees with eyes closed.

Or maybe, you might want to focus on stress reduction. Learning to manage your stress will help you to reduce your cortisol levels. And that will give your body a break in many ways, not just when it comes to potassium levels.

By increasing your potassium intake and then also reducing the common causes, you can help yourself avoid or prevent becoming hypokalemic.


Good sources of potassium

You need 4,700 mg of potassium every single day. That is a LOT of potassium.

Potassium has the highest RDA (recommended daily allowance) of all the minerals. And it is the most important electrolyte. Yet it is the hardest to get.

Swiss chard rainbow chard leaves in a big pile with different colors.

It takes eating 7-10 cups of vegetables per day to get enough potassium. I recommend everyone eats that amount of nutrient-rich vegetables every single day. That is so you get all the nutrients you need, especially potassium. Watch this video to see what 7-10 cups of salad looks like.

Some people think that bananas are the best source of potassium. But they aren't. There are many other foods that have far more potassium in them and that are much healthier for you.

These are some of the healthiest potassium-rich foods you can choose from:

  1. Beet greens
  2. Swiss chard
  3. Avocado
  4. Winter squash
  5. Spinach

Try including more of these into your daily diet. Get creative, and mix it up. Try steamed beet greens one day, a large spinach salad the next, and top all sorts of dishes with chopped avocado. Experiment and find what you enjoy.

Nutrition facts information label focused on potassium and grams of daily value.

Key takeaways

Potassium is essential for whole-body health. It plays a role in everything from your heartbeat to your digestion. I consider it to be the most important electrolyte there is.

When you don't have enough potassium in the body, many things can go wrong. It can lead to a variety of symptoms such as muscle weakness, arrhythmia, constipation, and more.

So it is important to keep your potassium levels in the healthy range. You'll want to avoid low potassium, also known as hypokalemia.

Hypokalemia can be caused by a variety of different factors, including:

  • Diuretics.
  • High cortisol and stress.
  • Diarrhea.
  • Vomiting.
  • Steroids.
  • Diet.
  • The keto diet (during keto-adaptation).
  • Diabetes and high Fat Storing Hormone.
  • Alkalosis.
  • Sugar and high fructose corn syrup.

To avoid hypokalemia, you need to do your best to avoid these causes and to boost your potassium intake.

This means doing what you can to reduce the factors listed above. For example, can you work to get off of your diuretics? Can you do better to manage your diabetes and lower your Fat Storing Hormone levels? Can you cut out sugar? Reduce stress?

And it also means being conscious of eating more potassium-rich foods. Try beet greens, avocado, Swiss chard, winter squash, and spinach.

Give these tips a try, and let me know how you do. Go ahead and leave a comment below with your thoughts and questions.

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Disclaimer: Our educational content is not meant or intended for medical advice or treatment.

Editor’s Note: This post has been updated for quality and relevancy.

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