Living in the big country

[Andrew D]

Have you ever wondered why you can't buy supplemental K (potassium) without an Rx?

No. But the prescription requirement will probably come as quite a surprise to the people who sell potassium supplements over the counter. People like these. And these. And these. And these. Etc.

[Rick]

From here

When doctors prescribe potassium supplements, it is usually in the range of 1,500 to 3,000mg per day.

Commercial potassium supplements in the U.S. are limited by the FDA to 99mg which happens to be the recommended daily allowance. A prescription is required for higher doses, even though an average banana may contain 500mg and popular "salt substitutes" made from potassium chloride provide 3,180mg of potassium per teaspoon!

I thought the following was interesting...

Although bananas have a popular reputation as a high-potassium food, potatoes contain twice as much potassium as bananas and some other vegetables even more. What the banana does have is the highest potassium-to-sodium ratio - 440:1.

[rubato]

Thanks Keld!

Exactly so.

You can get very small amounts of potassium (compared to therapeutic doses) in otc or food sources but Rx-only for the levels given medically for low potassium.

yrs,
rubato

[Andrew D]

Commercial potassium supplements in the U.S. are limited by the FDA to 99mg which happens to be the recommended daily allowance.

Really? I think not.

The FDA says that the "Daily Value" for potassium is 3500 mg. (See also this publication from the Department of Health and Human Services.) That probably explains why the label shown here for 99-mg potassium supplements, like every other label for 99-mg potassium supplements I have encountered, says that a 99-mg supplement provides only 3% (evidently a rounded number) of the Daily Value.

[Rick]

How does that change anything?

If 3,800 mg is the DV for the AVERAGE person, and a single banana contains 500mg it would stand to reason that high volume injestions of K should be doctor supervised.

There are probably dietary constraints that come along with that prescription...

[oldr_n_wsr]

Went for my physical the other day and hte doctor just called and told me I am lacking in Vitamin D. I told him I'll sit under a sun lamp (I'm not into pills/vitamins).
Heck, my turtle had the same problem and that's what the vet told me to do for him.

[rubato]

How does that change anything?

If 3,800 mg is the DV for the AVERAGE person, and a single banana contains 500mg it would stand to reason that high volume injestions of K should be doctor supervised.

There are probably dietary constraints that come along with that prescription...

Andrew was very excited because he thought he had found a nit, and you crushed his hopes. He might get over it some day. Be patient.

yrs,
rubato

[Andrew D]

Change anything about what? The assertion made by rubato that "you can't buy supplemental K (potassium) without an Rx" turns out to be false. The assertion made in the quoted article that "99mg ... happens to be the recommended daily allowance" turns out to be false.

The point which rubato apparently intended to support with his false assertion -- that some things which are necessary in small doses can be fatal in larger doses -- is dizzyingly obvious, and I have not disputed it. With even a modicum of care, he could have supported that point with a true assertion.

I do not know where rubato gets the idea that "[y]ou can get very small amounts of potassium (compared to therapeutic doses) in ... food sources," but what the quoted article says is quite different. It says that "an average banana may contain 500mg," that "potatoes contain twice as much potassium as bananas," and that "[w]hen doctors prescribe potassium supplements, it is usually in the range of 1,500 to 3,000mg per day."

I am not as smart as rubato thinks he is -- no one is as smart as rubato thinks he is -- but it seems clear that simply by eating two baked potatoes, one will consume an amount of potassium well within the "therapeutic" range prescribed by doctors. (2 x (500 mg x 2) = 2000 mg.) Of course, the article could be wrong about the potassium content of potatoes, just as it is wrong about the nutritionally proper amount of potassium.

I have not tried to "change anything". I have merely remarked two false assertions. But, quite unsurprisingly, to rubato, the difference between truth and falsity is a mere "nit".

[Big RR]

One could also eat 20 or 30 of the 99 mg supplements, and get the larger dose without a prescription as well.

[rubato]

Pore sad pathetic little AndrewD

The only thing you want in the world is to count coup against someone you hate, and you failed again.

Sorry!



yrs,
rubato

PS if you go online you will discover that you can buy HGH, human growth hormone, without a prescription as well. But the amount is so small that it is therapeutically meaningless and is probably too small to even detect by most methods. Does that mean you can buy HGH w/o a prescription? Only to AndrewD, not a sane person.

[Andrew D]

Pore sad pathetic little AndrewD

The only thing you want in the world is to count coup against someone you hate, and you failed again.

And yet, every time you -- who flatter yourself absurdly by suggesting that you are of sufficient significance to warrant hatred on any account -- and I engage in susbstantive dispute, your paltry attempts at reasoning end up squashed. Go figure.

[Andrew D]

One could also eat 20 or 30 of the 99 mg supplements, and get the larger dose without a prescription as well.

Indeed, it takes a bit over thirty-five of those supplements to get the FDA-decreed nutritionally proper amount of 3500 mg. Thus, rubato's claim that "the lethal dose is too close to the therapeutic dose" turns out to be typical rubato -- pure ignorant horseshit.

Suppose that my breakfast includes one cup of canteloupe, one cup of honeydew melon, and one cup of orange juice. (I can scarcely imagine consuming only one cup of orange juice with breakfast, but never mind.) For lunch, I enjoy a large bowl of my sister-in-law's mother's delicious borscht with one cup -- again, an amount I find implausibly small -- of milk. Over the course of the afternoon, I snack on one cup of raisins. My dinner includes one cup of Lima beans (yecch, but never mind) and, given the season, one cup of winter squash, and for dessert, I have one cup of plain yogurt.

According to ThePotassiumRichFoods.com, I will have consumed 6432 mg of potassium. According to the quoted article, I will have consumed more than twice the upper end of the range of "therapeutic" potassium.* Thus, according to rubato, I will have consumed "too close to" more than twice "the lethal dose".

Does any rational person actually believe that? Does even rubato actually believe that? Does anyone here actually believe that the day's food consumption which I have just described will bring about a lethal potassium overdose?**

And what is the lethal dose of potassium anyway? According to WebMD, "the Institute of Medicine ["the health arm of the National Academy of Sciences"] has set an adequate intake for potassium," the adequate intake for adults is 4700 mg per day, and "very high doses of potassium -- about 30 times the adequate intake -- can be deadly." Thirty times 4700 mg is 141,000 mg. The quoted article says that the therapeutic dose of potassium is 1500-3000 mg per day. So the lethal dose is about forty-seven times as much as the high therapeutic dose. Only in the parallel universe inhabited by rubato is "about forty-seven times as much" synonymous with "too close to".

So why does the FDA limit over-the-counter potassium supplements to 99 mg? Canada evidently does not, because 77CanadianPharmacy.com sells 1500 mg potassium supplements without a prescription.

The reason is plainly not the simple amount of potassium. As the quoted article observes, "popular "salt substitutes" made from potassium chloride provide 3,180mg of potassium per teaspoon!" So you can get thirty-two times as much potassium (which is still only about one forty-fourth the lethal dose) from a single teaspoon of salt substitute as from the maximum allowed potassium supplement, but the FDA does not require a prescription for salt substitutes or prohibit their sale in ordinary grocery stores.

The answer appears to be the untrustworthiness of US pharmaceuticcal companies reliably to produce slow-release over-the-counter potassium supplements. Reportedly, "very high concentrations of potassium ion (which might occur next to a solid tablet of potassium chloride) can kill tissue, and cause injury to the gastric or intestinal mucosa." And as one doctor observes:

If you make a potassium pill badly, out of the pure salt, as the pill sits up against the bowel wall it can release enough potassium to raise the concentration in that small area enough to kill tissue. So you get a bowel wall infarction, rupture, and hell to pay. The FDA doesn't let people sell potassium pills of high strength willy nilly precisely because it takes a pretty high tech system to make sure potassium leaches out of some matrix slowly enough to ensure this concentration tissue killing doesn't happen--- and the FDA can't police every supplement manufacturer making these things on a non-presciption basis. I surely know a few supplement makers I wouldn't trust to make an 800 mg potassium pill.

Needless to say, the problem doesn't arise with potassium disolved in water, or in juices, or with potassium in fruit (which has its own complex slow-K delivery system all in place already).

In sum, potassium supplements are available without a prescription, potassium supplements are available without a prescription in Canada in far higher doses than in the US, the therapeutic dose of potassium is nowhere near the lethal dose of potassium, any ordinary diet (healthy or unhealthy) can easily result in the consumption of far more than the therapeutic dose of potassium, and rubato is completely full of shit.

-------------------------

* Considering that the quoted article misstates the FDA-decreed nutritionally proper amount of potassium by thirty-five times -- a striking error even by rubato standards -- I am not brimming over with confidence in the accuracy of its other assertions. But rubato has enthusiastically embraced it.

** A person with a robust appetite can con consume a "therapeutic" dose of potassium simply by having a large burger and a large fries at a fast food restaurant. A Double Quarter Pounder with cheese: Double Quarter Pounder with cheese and aLarge fries from McDonald's contain 1629.6 mg of potassium. A Double Whopper with cheese and a King size fries from Burger King contain 1671.7 mg of potassium. A Classic Double burger and a Great Biggie fries from Wendy's contain 1755.9 mg of fries. But rubato would evidently have us believe that a person who consumes two such meals in a single day will drop dead.

[rubato]

Poor Andrew. You have so much hatred.

I went to the doctor several years ago, I don't recall what for, and my serum potassium was low so he prescribed a dose of KCl. We talked about dietary sources and I asked about supplements at which point he said that therapeutic doses were by Rx because that level was potentially fatal; he may have said harmful and I misremembered. Now MDs have to synthesize a lot of information and transmit it in very short appointments so I don't blame him for not taking an hour to talk about all the mechanisms. Also, to an internist a 'supplement' which has too low a dose to be effective in moving the peg for serum potassium is useless. He related the gist and that is what I passed on here.

A few facts from "Drug Facts and Comparisons 2006".

KCl is by prescription only in the US. The glucoronide and citrate salts are otc. I'm guessing that the bioavailability is greater for the former but this is a very complicated subject. Some things pass though the gut wall based on simple diffusion and hence need a concentration gradient to drive them. Others are actively transported and thus can be extracted more efficiently. I don't know which K is, although we certainly have a K 'pump' in nerve cells which allows them to work


High doses are by prescription only.


And one finds the sentence "Potassium intoxication may result from any therapeutic dosage" which generally speaking supports his statement.


I'm sorry about the hatred problem. You went so far off into irrationality in the thread on the oil spill that I just stopped caring about what you posted. I see its still an issue.

yrs,
rubato

[Andrew D]

I don't fully understand the thrust of that posting, but it says very little in response to the facts set forth in mine. I do not see any dispute that the lethal dose of potassium is far, far higher than the "therapeutic" dose as given in the quoted article. I do not see any dispute that a person eating a healthy diet can easily consume more than twice the "therapeutic" dose of potassium. I do not see any dispute that a person can consume a "therapeutic" dose of potassium by eating a burger and fries from a fast food restaurant. I do not see any dispute that potassium supplements fifteen times stronger than those available over the counter in the US are available over the counter in Canada. I do not see any dispute that the FDA's limit on the strength of over-the-counter potassium supplements is based not on how much potassium is dangerous to consume but on the FDA's inability to ensure that manufacturers of over-the-counter potassium supplements make them properly so as to ensure the gradual release of the potassium -- apparently not a problem in Canada.

The only thing that I see which deals with rubato's original false statement is his claim to have relied on his possibly faulty memory. The lethal dose of potassium is a very easy thing to ascertain; all one need do is bother to look for it.

But rubato does not display much interest in verifying things before asserting them as facts. Just recently, he graced us with this:

Amazing, you mean good works count? Don't tell the fundamentalists. ... "

Fundamentalists emphasize justification by works as opposed to justification by faith. This point is often made by Catholic theologians.

You have it ass-backwards.

yrs,
rubato

Now, one might think that before accusing someone else of having something "ass-backwards," rubato would have troubled himself to ascertain the facts. Had he done so, he might have encountered this:

Sola fide (Latin: by faith alone), also historically known as the doctrine of justification by faith alone, is a Christian theological doctrine that distinguishes most Protestant denominations from Catholicism, Eastern Christianity and some in the Restoration Movement.

* * *

Historic Protestantism (both Lutheran and Reformed) has held to sola-fide justification in opposition to Roman Catholicism especially, but also in opposition to significant aspects of Eastern Orthodoxy. ... Thus, "faith alone" is foundational to Protestantism, and distinguishes it from other Christian communions. According to Martin Luther, justification by faith alone is the article on which the church stands or falls.

Or any of a multitude of other sources.

The last time that I recall when rubato dipped into his well of medical "knowledge" was when we were all posting at The Other Place, and he claimed that psychiatrists do not treat schizophrenia. He was, of course, wrong.

What followed was the typical rubato pattern: (1) post something that is demonstrably wrong, (2) when someone demonstrates that it is wrong, respond with puerile insults, and (3) when the demonstrations of error have become so manifold that even he can no longer defend his error, run away without conceding it.

That appears to be why so many people have rubato on "ignore". They have simply grown weary of his pattern of ignorance, arrogance, and churlishness.

It has become my habit, when rubato makes a factual assertion in a thread in which I am interested, to verify it. (Unless, of course, that is unnecessary: In this case, I knew that his assertion that one cannot purchase potassium supplements without a prescription is false, because I have purchased them without a prescription on numerous occasions.) That is not because of my supposed "hatred" of rubato, about whom I know very little and care even less, but because the difference betwen truth and falsity matters to me. If it mattered similarly to him, he would not so often find it necessary to resort to personal invective when he is proved wrong.

And in this instance, he has been proved wrong; and as usual, he cannot bear it. Simple as that.

[Gob]

That appears to be why so many people have rubato on "ignore". They have simply grown weary of his pattern of ignorance, arrogance, and churlishness.

You forgot racism and childishness.

[Long Run]

Potassium defined: A gathering of:



+

[rubato]

The point, way back in the original context, was to give an example of something which was beneficial or even essential at one level and harmful at another.

I have shown adequate evidence that this example proves that point whether therapeutically useful doses are potentially lethal or only harmful. I have given the provenance of my understandings whether flawed or precise.


Sorry Andrew, your problems are your own. If you put me on "ignore" I will never care in this life or the next. LJ appears to have overcome his inability to control his need to drop shit-bomb posts by that mechanism. Please do consider it yourself.



yrs,
rubato

[Andrew D]

The point which rubato apparently intended to support with his false assertion -- that some things which are necessary in small doses can be fatal in larger doses -- is dizzyingly obvious, and I have not disputed it. With even a modicum of care, he could have supported that point with a true assertion.

[rubato]

The point, way back in the original context, was to give an example of something which was beneficial or even essential at one level and harmful at another.

I have shown adequate evidence that this example proves that point whether therapeutically useful doses are potentially lethal or only harmful. I have given the provenance of my understandings whether flawed or precise.


Sorry Andrew, your problems are your own. If you put me on "ignore" I will never care in this life or the next. LJ appears to have overcome his inability to control his need to drop shit-bomb posts by that mechanism. Please do consider it yourself.



yrs,
rubato

Still can't read. Can you?

[Andrew D]

Ah, rubato has made discovered a profound truth: When you can't persuade anyone else, talk to yourself.