A Low-Potassium Diet for Hyperkalemia

If you have chronic kidney disease, diabetes, or you're taking renin-angiotensin-aldosterone system (RAAS) inhibitors—which include ACE inhibitors and angiotensin II receptor blockers—your doctor will likely talk to you about how to manage your body’s potassium levels through medications and dietary changes.

Hyperkalemia, which occurs when you have too much potassium in your blood, is common in people with chronic kidney disease and diabetes and can be fatal if it gets out of control. Implementing a low-potassium diet can be instrumental in keeping hyperkalemia at bay.

Potassium is one of the major dietary minerals, along with calcium, magnesium, chloride, phosphorus, and sodium. It's essential for normal muscle and nervous system function and helps regulate your body's pH balance, working with sodium to maintain normal blood pressure levels.

Limiting Potassium

If you have had hyperkalemia or you're at risk for developing it, your doctor will likely have you work with a dietitian to help you create a low-potassium meal plan. The average adult should have up to 4,700 milligrams of potassium each day, but most people who have chronic kidney disease or are otherwise at risk for hyperkalemia need to stick to fewer than 2,000 milligrams per day. Your dietitian or doctor can help you figure out what amount you need to meet your personal health goals.

Since potassium essentially counteracts sodium in the regulation of your blood pressure, it's no surprise to learn that foods high in potassium are generally considered to be healthy foods, especially fruits and vegetables. In order to follow a low-potassium diet, you'll need to limit some healthy foods, but don't worry—there are plenty of healthy foods that you can still eat.

Along with reducing your potassium intake, it's also a good idea to avoid alcohol, high-fat foods, and fast foods that aren't very nutritious. It may also help to drink more water, so ask your doctor how much water you should be drinking every day.

Hyperkalemia is usually caused by illness or medication, but in rare cases, it can happen when you take large doses of potassium supplements. Although potassium is an essential nutrient, it's best not to use potassium supplements, unless directed by your doctor to do so.

Foods High in Potassium

Potassium-heavy foods (more than 200 mg per serving) need to be avoided or drastically limited when you're on a low-potassium diet. These foods include:

  • Vegetables: Cooked spinach, raw carrots, greens (except for kale), bamboo shoots, Swiss chard, taro, artichokes, sweet potatoes, baked or refried beans, potatoes, beets, bok choy, okra, cooked broccoli, raw cabbage, pumpkin, squash, parsnips, Brussels sprouts, and mushrooms as well as any snacks or side dishes made with these veggies
  • Fruits: Papaya, mangos, dried fruits, dates, nectarines, avocado, pomegranate, bananas, plantains, kiwi, oranges, yams, fresh pears, coconut, cantaloupe, honeydew melon, apricots, prunes, tomatoes, and all tomato products
  • Dairy: Dairy products, except for cheese and sour cream (noted in the next section), as well as yogurt, regular and flavored milk, and buttermilk
  • Beverages: Fruit and vegetable juices, instant breakfast mix, soy milk, and sports drinks like Gatorade or Powerade
  • Whole grains: Bran, granola, oats and oatmeal, bread, baked goods, and cereals made with whole grains
  • Dry beans: Pinto, kidney, black, and navy beans as well as tofu, lentils, Lima beans, and soybeans
  • Nuts and seeds: Most nuts, peanuts, peanut butter, and most seeds, including pumpkin and sunflower
  • Meat: Salmon, halibut, clams, scallops, sardines, lobster, most fish, and most red meats
  • Sugars: Molasses, chocolate, and fig cookies
  • Salt substitutes: While these may be sodium-free when potassium is used as a replacement for sodium, they become high in potassium. Do not use any type of salt substitute that has potassium. Instead, use herbal blends and seasonings.

Foods Low in Potassium

The above list seems like a rather long one, but there are plenty of foods that are lower in potassium (less than 200 mg per serving) that you can eat if you're at risk for hyperkalemia, including:

  • Vegetables: Green beans, wax beans, peppers, eggplant, cooked cabbage, cooked carrots, canned water chestnuts, asparagus (6 spears), cauliflower, celery (1 stalk), raw broccoli, cucumbers, corn (1/2 ear or 1/2 cup), alfalfa sprouts, kale, fresh mushrooms, okra, turnips, onions, parsley, green peas, rhubarb, radishes, snow peas, turnip greens, watercress, raw spinach (1 cup), yellow squash, zucchini, scallions, and iceberg lettuce
  • Fruits: Apples (1), applesauce, blackberries, blueberries, cherries, peaches (1/2 fresh or 1/2 cup canned), grapefruit, fresh plums (1), raspberries, grapes, cranberries, grapefruit (1/2), pears (1 fresh or 1/2 cup canned), mandarin oranges, canned apricots, canned fruit cocktail (drained), tangerines (1), watermelon (1 cup), pineapple, and strawberries
  • Dairy: Hard cheese (1 ounce), cottage cheese (1/2 cup), and eggs are all allowed on the diet. Rice milk makes a good substitute for cow's milk.
  • Beverages: Apple juice, grape juice, pineapple juice, non-dairy creamer, fruit punch, drink mixes like Kool-Aid, tea (limit to 16 fluid ounces per day), and coffee (limit to 8 fluid ounces per day)
  • Grains: White refined flour is fine—and so is white rice—so you can have corn chips, English muffins, crackers, popcorn, pasta, and cereals made with refined flour.
  • Nuts and seeds: One ounce of macadamia nuts, pecans, cashews, walnuts, almonds, sesame seeds, chia seeds, flax seeds, and unsalted peanut butter (1 tablespoon)
  • Sugars: Cookies without chocolate or nuts, pies without chocolate or high-potassium fruit, angel cake, and yellow cake
  • Meat: Fresh chicken (3 ounces), fresh turkey (3 ounces), tuna, fresh pork, baloney, and shrimp (all 1 ounce). Avoid sausage, bacon, or other meats that may have additives that contain potassium.

Unless otherwise noted, one serving equals 1/2 cup or 4 ounces. Keep in mind that if you eat large quantities of these lower-potassium foods, you're going to ingest more potassium than you should. Be sure to eat these foods in moderation and ask your doctor or dietitian if you have any questions.

Leaching Vegetables

If you really love certain vegetables that are high in potassium, leaching is a way to reduce some of it. Though this makes it possible for you to enjoy these veggies on occasion, they will still have too much potassium to eat regularly. You can talk to your doctor or dietitian for more information.

Here's how you do it:

  • Wash, peel (if needed), and thinly slice the vegetable
  • Rinse in warm water
  • Soak in unsalted warm water for at least two hours—about 10 parts water to 1 part vegetable, changing the water every four hours if you want to do it longer, up to 12 hours
  • Rinse in warm water again
  • Cook as desired in unsalted water—about 5 parts water to 1 part vegetable, and drain the cooking water

Sample Meals and Snacks

Here are some ideas for meals and snacks you can enjoy on a low-potassium diet.

Breakfast:

  • White toast with jam, a small glass of grape juice, and a hard-boiled egg
  • Cornflakes with rice milk and fresh blueberries, toast with butter, cinnamon, and sugar
  • Scrambled eggs, cottage cheese, and fresh strawberries

Lunch:

  • A sandwich made with white bread, sliced cucumbers, cream cheese, and dill weed
  • Chicken fajitas with white flour tortillas, peppers, onions, chili powder, and lime
  • White pasta with sliced asparagus, peppers, and onions with olive oil and herbs

Dinner:

  • Turkey meatloaf made with egg, white bread crumbs, parsley, and Worcestershire sauce, green beans, and white rice
  • Chicken with curry sauce, raw broccoli, cooked carrots, and a small salad made with iceberg lettuce
  • Lean pork chops with coleslaw and red beets

Snack:

  • White crackers with cheese slices
  • Cottage cheese with blueberries
  • Smoothie made with raspberries, rice milk, and crushed ice

General Diet Tips

Read the labels on all store-bought food items. New nutrition labels require potassium quantities to be displayed, but until then you can look at the ingredients list to make sure there are few or no potassium-rich foods.

Also, be sure to drain all canned vegetables, fruits, and meats before you eat them. This helps cut down on the potassium.

Water is a good beverage, but you can also drink lemonade and fruit juice made from fruit in the low-potassium list. Tea is also acceptable, as long as you stick to 16 ounces per day. It can be served hot or on ice with lemon and sugar or honey.

Always aim for healthy foods. If you need to lose or gain weight, talk to your doctor and dietitian who can help you determine the right number of calories to consume every day.

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