Dietetics - Controlling Your Potassium Intake: Step 2

What is potassium?

• Potassium is a mineral which is found naturally in many foods and drinks. Some potassium is needed as part of a healthy diet.It is required to ensure healthy functioning of muscle, including your heart muscle
• The level of potassium in your blood is usually controlled by the kidneys. When your kidneys are not working properly they become less efficient at removing potassium, causing the level in your blood to rise
• Too much potassium can be dangerous as it affects the rhythm of your heart and can cause a heart attack if levels are very high
• A low potassium diet may be needed to control the level of potassium in your blood. This leaflet explains which foods are high in potassium and need to be limited, and which foods are suitable alternatives. Your dietitian will give you individualised advice on the changes you need to make
• You should aim for a blood level of potassium between: ________ mmols/l

Milk and Dairy 

Lower potassium – Rice/oat milk allowed freely. All types of cheese (unless advised by your dietitian to restrict for other reasons). All types of cream, crème fraiche.

High in potassium – AVOID or use portion size if stated – Milk (including cow, sheep, goat and soya milk) – up to 300ml (1/2 pint) daily. Yoghurt, ice-cream, custard, milky puddings – up to 3 per week. Condensed milk. Evaporated milk. 

White sauces and cheese sauces should be made from allowances of milk and cheese.

Note: many ready prepared sauces are high in salt.

Carbohydrate (starchy foods)

Potatoes

Lower potassium – 150g (6oz) boiled potato daily* - these can be fried, mashed, roasted or sauteed after boiling. Boiled sweet potato/yam/cassava/plantain can be taken as all or part of the potato allowance. 

High in potassium – AVOID or use portion size if stated – Jacket potatoes. Chips (chip shop, frozen, microwave, oven chips). Manufactured potato products e.g. potato waffles, hash browns, croquette potatoes, potato wedges, frozen roast potatoes. Instant mash potato. 

* All potatoes are high in potassium but it is possible to reduce their potassium content by cooking them in the best way (see below for more details).

Rice, pasta and other grains

Lower potassium – pasta, rice, noodles, couscous, pastry, Yorkshire puddings, dumplings

Breads

Lower potassium – white, granary, wholemeal bread. Pitta bread, tortilla wraps, bagels, chapatti, crumpets, English muffins, croissants, crackers.

High in potassium – AVOID or use portion size if stated – bread containing nuts, seeds, dried fruit or chocolate. Naan bread: limit to ½ naan (80g) per day, Rye crispbreads. 

Breakfast cereals

Lower potassium –  Cereals that are free from bran, dried fruit, nuts and chocolate (e.g. Weetabix, Shredded wheat, Special K, porridge, Rice Krispies, Shreddies).

High in potassium – AVOID or use portion size if stated – Cereals and cereal bars containing bran, chocolate, dried fruit or nuts (e.g. muesli, All bran, Fruit & Fibre)

Cooking methods

The way you cook potatoes and vegetables can affect their potassium content. When they are boiled, some of the potassium is lost into the cooking water and this reduces the potassium content of the food. For this reason, you should:

• Boil vegetables/potatoes in plenty of water and make sure they are well cooked. Throw this water away after use. Do not use this water to make soups, gravy, curries or casseroles
• Peel potatoes before boiling if possible. Cut potatoes & vegetables up into small pieces before boiling
• Boil potatoes and vegetables before frying, roasting, or adding to casseroles, stews and curries

When little or no water is used to cook these foods, most of the potassium stays in the food. For this reason, you should:

• Avoid using a steamer, microwave or pressure cooker for cooking potatoes & vegetables
• Avoid stir-frying, baking or roasting (unless vegetables/potatoes have been boiled first)

Fruit & Vegetables

Fruit and vegetables all contain potassium, though some are higher than others. Those that are particularly high in potassium should therefore be avoided. It is good to eat a variety of fruit and vegetables rather than using up your entire allowance on one type. The recommended allowance of fruit and vegetables combined is 4 lower potassium portions daily.

A portion of fruit/vegetables is 80g (3oz). This is approximately the size of a small apple, a handful of small fruit (e.g. grapes), 2 tablespoons of vegetables or stewed fruit, or a small salad. Use the lists below as a guide to make the best choices.

Using tomatoes in your cooking

In addition to your fruit and vegetable allowance, you could choose to have a meal made with tomato based sauce, provided you don’t have potatoes that day as well. For example, you could serve a tomato based dish with pasta, rice, noodles, cous cous etc. One third of a 400g tin of tomatoes or one serving of a ready- made sauce would be equivalent to your daily potato allowance.

Vegetables

Recommended allowance of fruit and vegetables combined is 4 lower potassium portions daily

Lower potassium – asparagus, aubergine, beansprouts, beetroot (pickled), broccoli, carrots, cabbage, cauliflower, celery, (boiled) chickpeas, (canned) chicory, coleslaw, corn on the cob, cucumber, curly kale, courgette, gherkins (pickled), green beans, leeks, lettuce, mangetout, marrow, mixed vegetables (frozen), mushrooms (canned), olives, onions (boiled, pickled, raw), peas, peppers, pumpkin, radish, runner beans, salad (one handful is counted as one portion from your vegetable allowance), spring greens, sugar snap peas, swede, sweetcorn (baby/canned/frozen), turnip, watercress and water chestnuts (canned). 

High in potassium – AVOID – Artichoke, baked beans, bamboo shoots, beetroot (raw/boiled), broad beans, Brussel sprouts, butternut squash, celeriac, chard, chickpeas (dried) boiled, endive, fennel, kidney beans*, mushrooms (raw/fried/dried), okra, onion (fried – small portion allowed), Pak choi, parsnips, soya beans*, spinach (raw), split peas*, spring onions (small portion allowed), tomato (raw), tomato puree, sundried tomatoes, water chestnuts (raw). 

* See meat, fish and alternative table below. 

Fruit

Recommended allowance of fruit and vegetables combined is 4 lower potassium portions daily

Lower potassium – apple, blackberries, blueberries, cherries, clementines, cranberries, fig (fresh), gooseberries, grapefruit (half)*, grapes, lemon, lime, lychees, mixed peel, nectarine, orange (small), papaya, passion fruit, peach, pear, plum, pomegranate, raspberries, satsuma, strawberries, tangerine, tinned fruit except prunes (juice drained), watermelon.  1 portion of fruit can be swapped for 100mls of fruit juice. 

High in potassium – AVOID – Apricot, avocado, banana, blackcurrant, coconut, damson, dried fruit – all e.g. raisins, sultanas, prunes, figs, greengage, guava, kiwi, loganberries (raw), mango, melon, pineapple, redcurrants, rhubarb, Sharon fruit/persimmon, white currants.

* Please note grapefruit may interact with certain medications. Please speak to your doctor or pharmacist regarding this.

It is recommended that all patients with renal disease avoid star fruit as it may have dangerous effects.

Meat, fish and alternatives

Protein is important for building and maintaining muscle. Your dietitian may advise you on the appropriate amount of protein foods that you should have.

Lower potassium – meat and poultry – all types. Fish and seafood – all types. Eggs (unless advised by your dietitian to restrict for other reasons). Quorn. Tofu. 

High in potassium – AVOID – Nuts, seeds. 

Beans and pulses are high in potassium and should therefore be avoided.  However, a portion of beans or pulses (e.g. baked beans, lentils, chickpeas, kidney beans ) can be taken in place of a portion of meat or fish as a vegetarian meal. 

Savoury snacks

Lower potassium – Maize/corn/wheat based snacks e.g. tortilla chips, popcorn. Rice based snacks e.g. snack-a-jacks, rice cakes. Breadsticks. 

High in potassium – AVOID – Potato or vegetable crisps. Potato snacks e.g. Hula Hoops, French fried. Nus and seeds. Bombay mix and Chevra. Twiglets. 

Many savoury snacks are high in salt so even those lower in potassium should not be included too frequently in your diet. Food manufacturers are increasingly adding potassium chloride to foods. Check the label for potassium chloride in the ingredient list.

Confectionary*

Lower in potassium – Boiled/chewy/jelly sweets, marshmallow, Turkish delight, mints, chewing gum. 

High in potassium – AVOID – Chocolate, toffee/fudge, liquorice, Carob, confectionary containing dried fruit/nuts, evaporated/ condensed milk, dried milk powder or coconut milk.

* If you have diabetes, you will need to limit your intake of sugary foods and drinks.

Biscuits and cakes*

Lower in potassium – Plain biscuits (e.g. rich tea, digestives). Cream/jam filled biscuits, iced biscuits/cakes, shortbread, wafers, sponge cake/Swiss roll, doughnuts, jam tarts. 

High in potassium – AVOID – all cakes and biscuits containing dried fruit, nuts or chocolate.  All cereal bars containing dried fruit, nuts or chocolate. 

Puddings*

Lower in potassium – lemon meringue pie, jam/treacle pudding, fruit pie/crumble (using fruit from your allowance), pavlova (using fruit from your allowance), cheesecake (using fruit from your allowance). 

High in potassium – AVOID – all puddings containing dried fruit, nuts or chocolate. 

Beverages

If you are on a fluid restriction, ensure that all drinks are included as part of this allowance. Use sugar free drinks if you have diabetes.

Lower potassium – water, tonic water. Soda water, flavoured water. Squash/cordials, tea and herbal teas. Fizzy drinks – lemonade, Lucozade etc. Red bull. Camp coffee. 

High in potassium – AVOID – Coffee – limit to 1 cup per day. Fruit/vegetable juice. Hi juice squashes, fruit smoothies, drinking chocolate and cocoa and malted drinks (e.g. Horlicks, Ovaltine).

Alcohol 

Lower in potassium – spirits e.g. vodka, rum, gin, whisky. Sherry, port, vermouth. 

High in potassium – AVOID – Beer and larger, stout, cider, wine, champagne/sparkling wine. 

Miscellaneous 

Lower potassium – Herbs, spices, pepper, garlic, vinegar, mayonnaise/salad cream, mustard, jam/marmalade, lemon curd, honey, golden syrup, horseradish, chilli sauce, mint/apple/cranberry cause, pickles, piccalilli, gravy granules/powder. Butter/margarine/low fat spreads and oil (note fats and oils made from vegetables sources are better for your heart). 

High in potassium – AVOID – black treacle, peanut butter, tomato ketchup, tomato puree, brown sauce, marmite/vegemite, Bovril, chocolate spread. 

Take care with the quantity of salt added to your food – keep salt added to cooking to a minimum and avoid adding at the table. Salt substitutes (e.g. Lo-Salt, So-Lo) contain potassium in place of sodium. It is therefore important that salt substitutes are avoided.

Name: 

Dietitian:

Telephone: 0161 206 1994

Email: renaldietitians@nca.nhs.uk