Hello! I work for a very small community hospital, and everyone knows everything about everybody. Anyway - a doctor who knows I am going for herbalism approached me with a question. She has been finding with patients that are taking turmeric for one reason or another, that their serum potassium levels become high. She has not been able to find any research articles pertaining to this finding. I told her I would ask my professor if he has any clues as to why this may be the case. Thank you for any insight. I am just thrilled that physicians are actually taking my journey seriously. This would not have been the case even a few years ago. This physician is a cardiologist, by the way.

I have not seen this in practice and there is a difference between Curcumin and Turmeric, it would be interesting to see which his patients were actually taking and the quantity. I did find this case report with a theory as to how Turmeric could have caused the hyperkalemia. An Interesting Case of Turmeric-Associated Hyperkalemia Session Information Publication Only Category: Trainee Case Report 902 Fluid and Electrolytes: Clinical Authors Hasan, Shamir, Northwell Health, Port Washington, New York, United States Malieckal, Deepa A., Northwell Health, Port Washington, New York, United States INTRODUCTION Advancements and understandings of modern medicine includes the acknowledgement of homeopathic and holistic approaches to health maintenance taken on by our patients. We also need to be aware of the possible side effects associated with their use. Turmeric is a spice that is commonly used for its rich flavor but has been increasingly popular for its possible health benefits. CASE DESCRIPTION 67 yo M with history of HLD presenting for evaluation of long-standing hyperkalemia. Patient is active and uses a lot of supplements in order to preserve his health. The patient started the use of turmeric after 2005. He uses turmeric regularly and sprinkles it in all foods and in his teas daily. He exercises regularly and his only other medical problem is hyperlipidemia for which he was recently started on a statin. Vitals: BP 138/81, HR 67, SpO2 99%, Ht 5’10”, Wt 149lbs, BMI 21.21 Physical Exam was unremarkable. Patient was asked to stop the use of turmeric (active compound: curcumin) after lab work on 12/27/2018 showed elevated serum potassium of 5.7. Repeat lab testing later (2/14/19), showed improvement of serum potassium to 5.2. DISCUSSION We report a case of turmeric associated hyperkalemia as a possible cause of hyperkalemia. We also discuss the likely mechanism of action: curcumin interferes with the binding of extracellular potassium to Na-K ATPase, causing an increase in serum potassium levels. This dysregulation can lead to low-level hyperkalemia, causing undue harm to specific patient populations. Awareness of this mechanism allows physicians to make accurate diagnoses. Additionally, knowledge of supplementations causing such changes in electrolyte balance will hopefully inspire further research into alternative medicines and their risks and benefits as they pertain to our patients and their health. LAB RESULTS Date or range Serum potassium or range Serum creatinine or range 2/14/2019 5.2 (plasma K) N/A 12/27/2018 5.7 0.86 8/27/2018 5.8 N/A 7/17/2018 5.6 0.90 3/13/2017 5 0.82 3/4/2016 5.6 0.79 Oct 2011-Nov 2015 5.4-5.7 0.81-0.91 Mar 2006-Jun 2010 4.6-5.4 0.86-0.9 Dec 2000-Aug 2005 4.2-6.5 0.8-1 3/25/1998 4.1 0.8 6/1/1992 4.9 1.1

Thank you! I have passed on the information along. I will pass onto you if there are any patterns she is seeing. I know she told me it is with patients without kidney disease.

Hi David, I assume we will review this at some point, so I can wait to get the answer, but I was wondering after reading Kristin's question, if other potassium containing herbs like Bai Zhi root, american ginseng, alfalfa, dandelion root/leaf, etc...are also not recommended for people with hyperkalemia? I understand that tumeric and curcumin are high in potassium, as well as oxaltes and are to be used with caution with those who have kidney stones? Have you heard this? Lastly, tumeric and curcumin I have read also increase bile secretion and need to be used cautiously or not at all with those who have any biliary diseases or bile duct obstruction. What is your experience with this? Thank you. Janice

We will be spending a year learning materia medica in which many of these questions will be answered . I doubt Cucumin has a lot of potassium, turmeric is another story. The same is true for turmeric which does have high levels of oxalates, but curcumin does not. You do not use cholagogues/choleretics with people with bile duct obstruction, biliary disease depending on what it is, again may be a very different story. As for herbs containing potassium yes you would avoid any food or herb with high potassium levels if you have hyperkalemia. I doubt Bai Zhi or American Ginseng has very high levels . Good mineral analysis on most herbs is lacking.