Low potassium diet – incorporating African and Caribbean foods

Contents

Introduction

The diet advice in this booklet has been developed by experienced registered dietitians with knowledge of the diets of ethnic groups to help individuals with high blood potassium levels.

What is potassium?Potassium is a mineral that is found naturally in many foods. Some potassium is needed as part of a healthy diet. It is required to ensure healthy functioning of muscle, including your heart muscle.

Your potassium level should be 3.5 – 5.5mmol/l (3.5 – 6.0mmol/l if on haemodialysis)

Why is the level of potassium in my blood too high?The level of potassium in your blood is usually controlled by the kidneys. When your kidneys are not working properly, the potassium level in your blood may rise. It is quite common for people with kidney problems to have too much potassium in the blood. Your bowels also remove some potassium, so if you are constipated, the potassium in your blood may also rise.

Why do I need to control the amount of potassium in my blood?Too much potassium in your blood can be dangerous as it affects the rhythm of your heart and can cause a heart attack if levels are very high.

Can I tell if my potassium is high?There are usually no symptoms to indicate if your potassium is high and the reliable way to tell is a blood test.

What should I do to control my blood potassium levels?You can control your potassium levels by:

Following a low potassium diet Ensuring regular bowel habits If you are diabetic, ensuring good sugar control If you are on dialysis, keeping to your scheduled sessions

How do I follow a low potassium diet?This booklet provides information on which foods are high in potassium and need to be limited and offers lower potassium alternatives. Your dietitian will give you individualised advice on the changes you need to make.

Carbohydrate

Carbohydrates, also known as starchy foods, provide energy, vitamins and fibre. You should try to include something starchy at each meal to provide you with energy.

Examples of carbohydrates: Potato, sweet potato, cassava and yam Rice, Pasta and other Grains Breads Breakfast Cereals

Starchy Vegetables

Some starchy vegetables like potato, sweet potato, cassava and yam are particularly high in potassium and need to be limited in the diet (choose only one per day). Other starchy foods based on wheat or rice are low in potassium and are good alternatives to opt for. If you do not routinely include high potassium starchy vegetables in your diet, you may be able to allow for a higher intake of potassium elsewhere in your diet. Your dietitian can discuss this with you on an individual basis.

Low High

Rice/rice flour/tuwo masa/tuwo shinkafa Steamed/fried/baked yam

Semolina/Semovita fufu Steamed/fried/baked cassava

Cornmeal Steamed/fried/baked plantainMillet Steamed/fried/baked breadfruitCouscous Steamed/fried/baked dasheenAbolo (made with rice or maize) Quinoa

UgaliKenkey

BreadBagel Cocobread

CroissantBreads with seeds/nuts/dried fruit/chocolate

BunHard dough breadPitta breadWholemeal/white/granary bread

CerealsOgi Cereals with dried fruit/nuts/chocolatePap/MielepapRice KrispiesCornflakes/Kooko/Tombrown/AkamuPorridgeShredded wheatShreddiesCoco popsBranflakes

Starchy vegetables- only have once per day (contains 11mmols or less)Cassava (boiled) 160gTaro/dasheen (boiled) 140gPotatoes (boiled, new) 170gSweet potato (boiled) 145gBreadfruit (boiled- data not available)Yam (boiled) 165gPlantain (boiled) 100gIf you are having foods made with these ingredients, e.g. plantain fufu or amala made with cassava/gari, please include these foods in the allowance.

Many may have larger portions than the above for starchy carbs. The dietitian could look at baseline K level when the patient was last eating these portions and use this to guide them as to whether they can be included.

Fruit and Vegetables

Fruit and vegetables are a good source of vitamins, minerals and fibre and form a large part of a healthy balanced diet. The potassium content of all fruits and vegetables vary and these are listed in the table below as low, medium and high. Vegetables with very high potassium content as listed below should be avoided.

Aim for a total number of 4-5 portions of fruits and vegetables daily (or as advised by your dietitian). Make most of your choices from the Low or Medium category from the table below. If you are choosing from the High column, you may need to reduce the number of fruit and vegetable portions you have that day.

All vegetables should be boiled, rather than steamed or microwaved. Boiling allows some of the potassium to leach into the water which should be thrown away and NOT used for gravy or stock.

Vegetables can be blanched by boiling for approximately 1 minute and draining before using in stir fries, casseroles, stews, curries and soups.

Vegetables:

________ portions of vegetables can be taken daily.

A portion of vegetables is 80g. The potassium content of all vegetables varies and these are listed below as low, medium and high. There are a number of vegetables where the potassium content is very high and these should be avoided. If one portion of vegetables is not taken, then you can swap for an extra portion of fruit.

Low <3mmols/80g Medium (3-5mmols/80g)

High (5-7mmols/80g)

Avoid (>7mmols/80g)

canned mushrooms Broad beans cannedMangetout peas raw/fried Amaranth (raw)

canned green beans Courgette boiledMixed vegetables canned cassava leaves (raw)

marrow Carrots young boiledOkra boiled

Taro leaves (raw)

canned okraColeslawCocoyam leaf boiled Lentils red boiled

Drumstick leaves (raw)

Cabbage boiledCurly kalePepper yellow raw Lettuce average raw

cocoyam leaf (Xanthosoma sagittifolium)- raw

Peas frozen boiledLeeks boiled

Sweetcorn cannedAsparagus

Asparagus - raw/fried (tough base removed Jute leaves (raw)

Cauliflower boiled Pepper red rawSpring onions raw edible parts

Vernonia leaves (raw)- bitter leaf

Pepper green raw Spring greens boiled Cabbage raw Okra (fried)

Mixed vegetable - frozen

Green salad lettuce, cucumber, pepper, celery Chick peas boiled Avocado

Peas - sugar snap raw

Aubergine - fried/baked mung beans boiled

Baby spinach (boiled or raw)

Peas canned Broccoli boiled Peas split boiledPumpkin raw Chicory raw Tomatoes (tinned)

Runner beans Mangetout boiledDrumstick leaves (boiled)

Butternut squash - boiled

Sweetcorn - baby boiled

cocoyam leaf (Xanthosoma sagittifolium)- boiled

Cucumber raw Green/French beans Jute leaves (boiled)

Marrow rawSquash e.g. butternut boiled

Vernonia leaves (boiled)

mung beans sprouted Broad beans canned

Pumpkin leaves (boiled)

Onion rawSweetcorn - weighed on the cob Celery boiled Ackee (canned)Water chestnuts canned

Mixed vegetables stir fried

Spinach boiled (not the baby type)

Pumpkin (boiled) Spinach boiledTaro boiled

Watercress rawCassava boiled

AsparagusAmaranth boiled

Lentils red boiledLettuce average rawCho-cho/christophene (boiled)Pepper yellow rawSweetcorn cannedCelery boiledMixed vegetables stir friedSpinach boiledWatercress raw

Beans and peas such as kidney beans, gungo peas and foods that contain beans such as akari and moin-moin can be high in potassium. Please discuss these with your dietitian as

this will depend on what your potassium levels were like when you had them in the diet and also your current kidney function.

Fruit

LOW MEDIUM HIGH

Apples, 1 small Apples, baked 1 medium Apple (dried)

Blackberry & apple (stewed) 3 tbsp

Apricots (canned) 3 halves Apricots (stewed), 4 halves

Blueberries, 40 Blackberries, raw, 16 Apricots, 2

Cherries (canned) 1/3 large tin Blackberries (stewed) 2 tbsp Banana, 1 small

Clementine, 2 small/1 medium Blackcurrants (canned), 2-3 tbsp coconut, dessicated, 1 tbsp

Cranberries, (dried) 1 tbsp Cherries, 20 Currants, 1 tbsp

Cranberries, fresh, 2 tbsp Cherries (stewed), 2 tbsp Damsons, 3 fruit

Fig, 1 fruitFruit salad, homemade, 2 tbsp Dried mixed fruit, 1 tbsp

Fruit pie fillingGooseberries (stewed), 2 tbsp Elderberries

Fruit cocktail (canned) 1/2 small tin Grapefruit, 1/2 fruit Loganberries (stewed) 2 tbspGooseberries (canned) 3 tbsp Grapes, 16 Mulberries, 2 tbspGooseberries (stewed) 2 tbsp Greengages, 1 fruit Nectarine, 1 mediumGrapefruit (canned) 1/4 tin Guava, 1 small Oranges, 1 mediumGuava, (canned) 1/2 tin Kiwi fruit, 1 medium Ortaniques, 1 fruitLemon Kumquats, 10 Pear (dried)Lime Loquats, 6 Pineapple (dried)Loganberries (canned) 1/2 tin Lychees, 5 Plum, 2 smallLongans, (canned) 1/3 can Mango, 2 slices Pomegranate, 1/2Lychees (canned) 6 fruit Medlars, 1 Prickly pears, 1 medium fruitMandarin oranges (canned) 1/2 small can Melon, 1/2 slice Prunes (dried) 3Olives, green, in brine, drained, 20

Mulberries (stewed), 2 tbsp Prunes (stewed), 6 fruit

Oranges, 1/2 medium Papaya, 1/2 slice Quinces, 1/2 fruitPassion fruit, 2 fruit Pear, 1 small Sharon fruit, 1 fruit

Peach, 1 small Physalis, 10 fruitSugar apple (custard apple), 1/2 med fruit

Peach (canned) 2 halves Pineapple, 1 slice Tamarillos, 1 fruit

Pear (stewed), 2 halvesPlums (stewed), 3 halves

Pear (canned) 2 halves Raspberries, 16 Very High (avoid)Pineapple (canned) 2 rings/12 chunks

Raspberries (stewed), 2 tbsp Apricots (dried)

Plums (canned) 4 halves Sapodilla, 1 fruit Avocado, 1/2 pear

Pomelo, 1/4 fruit Strawberries, 7-9 fruit Blackcurrants (stewed)Rambutan 8 BaobabRaspberries (canned) 1/2 can Dates (fresh/dried) 5Rhubarb (canned) 1/3 tin Figs (dried)Satsuma, 2 small Goji berries (dried)Strawberries (canned) 1/2 tin Greengages (stewed)Tangerine, 1 medium Grenadillas, 2 fruitWatermelon, 1/2 slice Longans (dried)

Prunes (canned/stewed)RaisinsRedcurrants (stewed)Rhubarb (stewed)SultanasWhitecurrants (stewed)

Protein

Protein is necessary for growth and repair and the building and maintaining of muscle. Your dietitian will suggest the amount of protein required according to your current nutritional status. General advice on protein foods include:

Choose either lean meat or chicken or fish or eggs or beans or lentils two to three times a day.

Cured and salted meats, chicken, fish are high in salt. These foods must be kept to a minimum.

Nuts and seeds are high in potassium and may need to be restricted. If you need to use small amounts in cooking, please discuss with your dietitian.

A portion of beans or lentils such as, baked beans, chickpeas and black beans can replace a portion of meat or fish. If you are vegetarian, continue having beans or lentils as usual

Dairy Products

Milk and dairy products play an important role within our diet as they contain essential nutrients such as calcium, which is needed for healthy bones, and protein which is needed for growth and repair of tissues. However milk is quite high in potassium therefore milk should be limited.

An equivalent of ½ pint (300ml) milk may be taken daily. This includes cow’s, sheep’s, goat’s and soya milk. Milky puddings, yoghurts and milk-based

sauces should be counted within this allowance. For example, milk on cereal (100ml) and a small pot yoghurt would be equal to ½ pint milk allowance.

Rice and oat milk are very low in potassium and can be taken freely (please note rice and oat milks are not a protein source).

Milkshakes, dried milk powder, evaporated milk, condensed milk, coconut milk and coconut cream are all high in potassium and therefore should be restricted.

Eggs, creams and cheeses may be eaten as usual on a low potassium diet, but may need to be limited if on a low phosphate diet. If you are unsure please consult your dietitian.

Snacks

 Snacks are generally high in energy (calories), and many are high in salt or sugar and fat, and therefore should make up only a small part of your overall diet. Fruits within your fruit and vegetable allowance are a healthier, lower calorie, low sugar and low salt snack. Please note, if you have a poor appetite or are losing body weight, snacks can play a helpful role in maintaining or improving your health. Your dietitian will be able to guide you in making the best choices for you. As with all food items, the potassium content varies and so they are listed below as low, medium and high. In accordance with your dietary intake, your dietitian will guide you as to which snacks that are safe for you to consume.

Savoury snacks

Crisps can be high in potassium for a number of reasons. Potato is naturally high in potassium, as are other root vegetables such as parsnip and beetroot used in vegetable crisps. Some new varieties made with lentil flour are also high in potassium. Additionally, some crisp varieties have potassium chloride added as a salt substitute as part of the government drive to reduce sodium content in foods. This may depend on the flavour but should be displayed on the ingredients list.

Low HighPopcorn Potato crisps

Tortilla chips

Kuli KuliNutsSeeds (if you are adding to soups/stews e.g. egusi, ogbono- please discuss with your dietitian)

Mini Cheddars/cheese flavour crackers KelewelePretzels

Many non-potato crisps e.g. Monster Munch, Wotsits etc. change ingredients very frequently by adding a salt substitute which can be high in potassium. For this reason, these foods have not been included in the diet sheet but please ask your renal dietitian who can provide more up-to-date information about this.

Sweet snacks

Low Potassium <2mmol High potassium

Biscuits - plainDigestive Biscuits containing

nuts,Rich Tea Chocolate, dried fruitshortbreadGingernutWaferSandwich biscuitCream filledJam filledBiscuit – semi-sweetMarie

Cakes and DesertsSponge cake – plain, cream, jamRing doughnut Scone containing

dried fruit

Plain scone Rich fruit cake1 slice Swiss roll Banana breadMeringue FlapjackJelly CheesecakeBulla Trifle

SweetsBoiled, chewy, fruit pastilles Fruit gumsJellies, marshmallows Liquorice AllsortsMints, sherbert,Turkish Delight28g Popcorn

Chinchin Shuku Shuku

Milky puddings (from dairy allowance)120g Custard66g Ice cream125g Yoghurt

Drinks

Low <1 High >1Barley water, squash MiloCola drinks Peanut punchCoffee, infusion Egg nogFruit squash Drinking chocolate with milkHerbal Tea, infusion Juices

HorlicksLemonade Carrot juice/vegetable juiceLucozade Evaporated milk/condensed milkOvaltine with water Malted drinkTonic water Milk shakeTeas Ovaltine with milk

Tomato juice

AlcoholLow <1 High >1Gin Beer, bitter

Vodka Cider, dry & sweetWhisky LagerLiquers Lager, alcohol freeShandy Port

Stout, GuinnessRed wine

Sherry, small glass Rose wineVermouth, dry White wine

Other ingredients

Akaun/akawn (Nigerian Potash) is high in potassium, so avoid using this as a meat or okra tenderiser.