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Potassium is a major dietary mineral that is essential for keeping your nervous and cardiovascular systems functioning. But, as with most anything, there is such a reality as too much of a good thing. A low-potassium diet may be one of the first treatments recommended in cases of hyperkalemia, the medical term for having too much potassium in your blood. The condition is common in people with chronic kidney disease and diabetes, and it left untreated, can be fatal.

Verywell / Cindy Chung

Benefits

Your kidneys regulate potassium in your body. Certain health conditions and some medications can affect how well your body gets rid of excess potassium, making your levels too high (hyperkalemia) or too low (hypokalemia).

An Overview of Hyperkalemia

Health conditions that can lead to hyperkalemia include chronic kidney disease, kidney failure, type 1 diabetes, and Addison's disease. Examples of medications that may do the same include renin-angiotensin-aldosterone system (RAAS) inhibitors and angiotensin-converting enzyme (ACE) inhibitors.

If your potassium levels are high for a long time, you may be more likely to have damage to your muscular and nervous systems. One of the reasons this can happen is that it may take months for your potassium to get to a dangerous level. During that time, you may not have any symptoms.

Your healthcare provider may recommend monitoring your potassium and following a low-potassium diet in these cases to get ahead of this potential risk.

Normal potassium levels are between 3.5 to 5.0 mmol/L. If your potassium levels are 6.0 mmol/L or higher, immediate intervention is necessary.

A low-potassium diet may help keep potassium levels in check, and some research has shown that certain negative effects of high potassium may respond to this way of eating.

For example, a 2017 study published in the Clinical Journal of the American Society of Nephrology found that patients with stage 3 or 4 chronic kidney disease were less likely to experience neuropathy on a potassium-restricted diet.

The benefits of a low-potassium diet for everyone at risk, however, are debated by some. Several research studies have looked at whether potassium-restricted diets are helpful for certain people, such as patients with kidney disease who are on dialysis. A 2016 study cited inconclusive evidence of a strict low-potassium diet's effectiveness, in part because it's unclear whether the body considers all dietary sources of potassium (plant and animal) equal.

The study's findings also suggest potassium-restricted diets may do more harm than good for some patients. However, because there are no other evidence-based dietary treatments for hyperkalemia, most researchers believe healthcare providers should continue to prescribe low-potassium diets.

How It Works

The average adult needs between 3500 and 4500 milligrams (mg) of potassium each day. If you have hyperkalemia or are at risk for developing it, your healthcare provider will likely have you design your low-potassium diet so that your intake of potassium is 2,000 mg per day.

The basic guidelines, of course, are as simple as you'd imagine them to be: Eat foods that are low in potassium and steer clear of those that are good sources of the nutrient. Doing this, however, means that you will need to limit some otherwise healthy foods. Potassium-rich foods, including many fruits and vegetables, are staples of a balanced diet and provide a great deal of nutrition.

You'll need to ensure that your low-potassium diet is full of low-potassium options that pack substantial nutrition; you may also be able to include small portions of high-potassium foods in your diet. Working with a registered dietitian can help you create a low-potassium meal plan that is both effective and nourishing.

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Duration

If your potassium levels are high due to a chronic health condition, you may need to make permanent changes to your diet to keep your levels managed. Depending on the cause of hyperkalemia, your healthcare provider may allow you to add more potassium back into your diet. However, if your potassium levels get high again, you will likely need to resume a potassium-restricted diet until they are under control.

In some cases, following a potassium-restricted diet may not be enough. If your potassium levels don't respond to changes in your diet, you may need to take medication or have dialysis treatments.

What to Eat

Most foods contain some potassium. If you're on a potassium-restricted diet, you'll need to avoid foods that are high in potassium (generally over 200 mg per serving). You'll also need to avoid consuming large quantities of any food or drink that contains potassium—even low amounts—as this can also raise potassium levels.

Your healthcare provider and a dietitian can help determine how many servings of low-potassium foods (generally 150 mg or less per serving) you can have each day.

Compliant

Chicken or turkey (3 ounces)
Tuna, pork, shrimp (1 ounce)
Green beans
Peppers
Eggplant
Canned water chestnuts (drained and rinsed)
Onions
Parsley
Snow peas
Rhubarb
Radishes
Asparagus
Cauliflower
Cucumbers
Corn
Kale
Scallions
Zucchini
Watercress
Carrots (cooked)
Apples, applesauce
Blackberries, blueberries, cranberries, raspberries, strawberries, cherries
Peaches
Grapefruit
Plums
Grapes
Pears
Mandarin oranges
Tangerines
Canned fruit cocktail (drained and rinsed)
Watermelon
Pineapple
Hard cheese
Cottage cheese
Egg whites
Refined white flour bread, pasta, and cereals
White rice
Corn chips, crackers, popcorn
Apple, grape, pineapple juice
Rice milk
Non-dairy creamer
Powdered mixed drinks
Iced or hot tea (16 oz/day) and coffee (8 oz/day)
Yellow cake, angel food cake, cookies without nuts or chocolate, pies without high-potassium fruit or chocolate

Non-Compliant

Most fish
Shellfish (e.g., clams, scallops, lobster)
Red meat
Greens (except kale)
Artichokes
Potatoes, sweet potatoes, yams
Bok choy
Squash
Parsnips
Brussels sprouts
Mushrooms
Pumpkin
Okra
Beets
Papaya
Mango
Dried fruit
Dates
Nectarines
Avocado
Pomegranate
Bananas
Plantains
Kiwi
Oranges
Pears
Coconut
Cantaloupe
Honeydew melon
Tomato, tomato products
Apricots
All dairy products (except some cheese and sour cream); soy milk
Pinto, kidney, black, lima, soy, and navy beans
Tofu
Lentils
Bran
Granola
Oats and oatmeal
Whole-grain bread, baked goods, and cereal
Nuts and seeds (limited portions may be approved)
Nut butters
Molasses
Chocolate
Figs
Fruit and vegetable juice
Electrolyte-replacement/sports drinks

Fruits and vegetables: Fresh produce is generally rich in potassium. When eaten raw, many fruits and veggies are too high in potassium for a low-potassium diet. However, you may be able to have them if you limit portions and/or cook them to reduce the potassium content. Some canned fruits and vegetables can also work as long as you drain and rinse them.

Dairy: Milk products need to be avoided, or at least limited, on a low-potassium diet. You may be able to have a small serving of milk or yogurt each day. Some types of cheese (including cottage cheese) are low enough in potassium that you may be able to include them in your diet.

If you add milk to your tea or coffee, switch to a non-dairy creamer or milk alternative such as rice milk. However, avoid soy milk.

Grains: Instead of whole grains and bran, look for rice cereals or bread made from refined flour. White rice and pasta noodles made from refined white flour are approved on a low-potassium diet. Soda crackers, unbuttered popcorn, and puffed rice are lower-potassium snack options.

Protein: Most animal and plant-based protein are high in potassium. However, you need to include some protein in your diet. Choose lower-potassium options or have smaller portions of high-potassium sources.

Egg whites are one lower-potassium option. You may be able to have small servings of nuts (one small handful) or peanut butter (a single tablespoon).

Avoid sausage, bacon, lunch meats, and any other processed meats with additives that may contain potassium. Whenever you cook meat of any kind, be sure to drain the juices and discard them instead of using them for sauces, basting, or gravy.

Sweets: Many desserts are made with ingredients that are high in potassium, such as nuts, syrups, and chocolate. Be careful when choosing cookies, cakes, and ice cream. Look for plain yellow cakes (such as angel food or sponge cake) with no icing, frosting, toppings, or fillings.

Clear gelatin, honey, and maple syrup are lower-potassium choices. If you're baking, white sugar is a lower-potassium choice than brown sugar.

Beverages: Dehydration can disrupt the electrolyte balance in your body and lead to hyperkalemia. Water is the best choice for staying hydrated, but other approved beverages on a low-potassium diet include fresh lemonade and juice made from low-potassium fruit or frozen fruit concentrate.

One eight-ounce cup of iced or hot coffee a day is OK. Tea is also acceptable, as long as you stick to 16 ounces per day. It can be served hot or on ice either plain or sweetened with lemon and sugar or honey. Avoid high-potassium herbs such as alfalfa, dandelion, and nettle, which are often used in tea (and seasoning) blends.

You may want to avoid drinking alcoholic beverages if you're on a low-potassium diet. In fact, consuming large amounts of alcohol is a risk factor for hyperkalemia.

Cooking Tips

If you don't want to completely give up your favorite high-potassium produce, you'll want to learn how to leach vegetables. While this cooking method can make some higher potassium foods safer to eat, talk to your healthcare provider before you add leached vegetables to your diet.

Even if you remove some of the potassium from a vegetable, you'll still want to only have it on occasion.

How to Leach Vegetables

Wash veggies in cold water.
Peel and thinly slice them, then rinse under warm water.
Add unsalted warm water to a pot or bowl (you'll need a ratio of about 10 parts water to one part vegetable).
Soak vegetables for at least two hours. You can soak for up to 12 hours, just be sure to change the water every four hours.
Remove vegetables and rinse them in warm water.
Boil in unsalted water using a ratio of about five parts water to one part vegetable.
Be sure to drain the cooking water when finished, as that's where the leached potassium has collected.

Modifications

If you typically eat a varied diet, reducing or eliminating certain foods will be easier than if you are on a very specific type of diet.

For example, people following a vegetarian diet may find a low-potassium diet challenging because plant-based diets are typically built around potassium-rich fruits, vegetables, nuts, and beans; lower-potassium foods such as meat are avoided. Vegan diets also exclude eggs and dairy products.

Other diets limit the amount of refined grains, which can be low-potassium choices.

If you follow a plant-based diet and have hyperkalemia, it may be helpful to seek guidance from a registered dietitian to ensure you're able to get the nutrition you need.

Considerations

While pretty straightforward, there are some things you need to be aware of when beginning a low-potassium diet.

Safety

If you are following a low-potassium diet, you may choose to take supplements to bridge the gap in terms of the nutrition your diet provides and what your body needs. Taking supplements that contain potassium can thwart your eating efforts, so be sure to read labels carefully. In fact, it is best to run any supplements you are considering by your healthcare provider first.

Flexibility

It's possible to dine out on a low-potassium diet, but you may need to exercise extra caution when evaluating your options.

Choose low-potassium foods and keep an eye on portions, which are often over-sized at restaurants. That said, you may find it easier to do this when preparing your own meals.

Dietary Restrictions

You may have other dietary needs and preferences to consider along with your low-potassium diet. For example, you may need to avoid gluten due to celiac disease, or you may prefer to follow a plant-based diet.

As additional dietary restrictions only enhance the challenge of getting proper nutrition while on a low-sodium diet, it's best to get professional help to figure out how to meet all your dietary needs.

Additionally, if you have another health condition that can be affected by your diet, such as high blood pressure (hypertension) or diabetes, your healthcare provider may have you make other changes to what you eat and drink.

If you're overweight or have other risk factors (such as a family history of heart disease) your healthcare providerr may suggest you limit your fat intake. High-fat, high-cholesterol foods not only put stress on your kidneys, but they can also contribute to obesity and conditions such as atherosclerosis.

Side Effects

The most common side effect of a low-potassium diet is constipation. If you're not able to increase your intake of fiber-rich foods to help things along, your healthcare provider may suggest a fiber supplement.

You should also be aware of the signs of an acute spike in your potassium levels, which can be dangerous. More subtle symptoms of hyperkalemia include general fatigue and nausea, but acute hyperkalemia can cause trouble breathing, a racing heart, and chest pain. If you have these symptoms, seek immediate emergency medical care.

Low-Potassium Diet vs. Other Diets

If you have hyperkalemia due to chronic kidney disease, your healthcare provider may put you on a renal diet. Sodium-restricted diets and restricted fluid diets may also be prescribed separately, depending on your needs.

On a renal diet, you will reduce your intake of sodium, phosphorus, protein, and sometimes fluid, in addition to limiting your potassium intake.

Your potassium levels are related to your body's sodium levels. If your potassium levels are high because your kidney function is poor, your healthcare provider might tell you to watch your salt intake to make sure you don't put too much stress on your kidneys.

If you have high blood pressure, you may be prescribed a sodium-restricted diet. However, if you are also on a low-potassium diet, you would need to avoid popular salt substitutes, as they are often made with potassium.

Drinking a lot of water or other fluids makes your kidneys work hard. If your kidney function is impaired, your healthcare provider may ask you to restrict your fluid intake. Proper hydration is essential to your overall health, so you will need to closely follow your healthcare provider's orders to avoid dehydration. They will help you determine your individual fluid needs.

A Word From Verywell

Potassium is an essential mineral the body needs to function properly, but sometimes too much builds up in the blood. Usually, this happens because of a medical condition.

Your healthcare provider will likely want you to try eating less potassium-rich foods to help lower your levels. You may also need to take medications or restrict other elements of your diet, such as sodium or fluid, to get your potassium levels back to normal.

Having dangerously high potassium levels is a medical emergency. While high potassium doesn't always cause symptoms, if you experience chest pain, trouble breathing, or heart palpitations, go to the emergency room.

Frequently Asked Questions

How much potassium is in an egg?

One large egg contains about 63 mg of potassium. Eggs are considered a low-potassium food, but check with your doctor or dietitian to find out how often you should eat them.
What meats and fish are best for a low-potassium diet?

Beef and most types of fish are usually higher in potassium than chicken, turkey, and tuna. For example, a 3-ounce ground turkey patty has 288 mg of potassium, a 3-ounce serving of canned tuna has 283 mg, a 3-ounce serving of salmon has 387 mg, and a 3-ounce steak has about 360 mg. Your doctor or dietitian can help you decide which to eat and how to watch your portions.

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Source: https://www.verywellhealth.com/diet-for-managing-hyperkalemia-4138591

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