Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
The relationship between minerals and human body is well known. There are so many minerals that are essential for the human body, for carrying on many functions in the body and for maintenance of health. On the other side the presence of these minerals in excess or low quantities than desired may prove dangerous to the body. It may lead to mal-functioning of many organs and also to manifestation of many systemic disorders. Potassium is one such important mineral.
In this article, I will focus on the dangers caused by high potassium in terms of kidney disease or kidney damage and also the remedy for the same in terms of a trending approach called as ‘leaching of vegetables’.
Need of Potassium:
Potassium is a mineral in many foods that we take. It helps in proper functioning of heart and muscles. It keeps the heartbeats regular.
The right quantity of potassium in the body is maintained by the kidneys. It helps in clearance of excess potassium from the body. When the kidneys are diseased, you need to limit the foods which have high potassium. These foods can increase the potassium levels in the blood to dangerous levels.
The Kidney-Potassium Connection
Kidneys clean your blood of excess fluids and waste products. When kidneys function normally, they can filter about 110-140 liters of blood each day. From this, the kidneys produce 1-2 liters of urine. This helps prevent waste buildup in the body. It also helps to keep the electrolytes including sodium, potassium and phosphates at normal levels.
People with kidney disease have diminished kidney function. They are typically unable to regulate the potassium levels in the blood effectively. This can cause increase in potassium in blood. Some medicines used to treat diseased kidney also raise the levels of potassium in the blood.
High potassium levels develop over a period of weeks and or months. If potassium spikes suddenly, one may feel difficulty in breathing, chest pain, palpitations etc symptoms. This suggests a case of emergency. This condition is called Hyperkalemia.
People having Chronic Kidney Disease (CKD) should keep a watch on their potassium quantity included in their diet. It is the kidney which regulates potassium levels in the body. If the kidneys are nor working properly or if they are damaged or diseased, potassium may not be flushed out of the body properly. This means to tell that the diseased kidney will not be in a condition to throw away excess potassium which is not needed to the body.
To do this, the patient with CKD should stick to low potassium diet. The diet shall consist of 1,500 – 2000 milligrams of potassium per day, not more than that. Limiting phosphorus, sodium and fluids may also be important for people with kidney dysfunctions.
Effect of excess Potassium in the body (blood)
High level of potassium in your blood can cause an irregular heartbeat or a heart attack.
Too much potassium in the blood can cause –
- Heart attack
- Muscle weakness
- Irregular heartbeat
Symptoms of high potassium levels are –
- Weakness in the body
- Tingling in body parts
- Chest pain
- Irregular pulse
- Erratic or low heartbeat
Safe and unsafe levels of Blood Potassium
3.5-5.0 mmol/L – safe zone
5.1-6.0 mmol/L – You are at risk, take caution (Caution Zone)
6.1 mmol/L and higher – Need to consult doctor and get your potassium levels balanced (Danger Zone)
What is meant by percentage of potassium?
Percentage daily value of potassium is based on a 2,000 calorie daily diet. In general, % of potassium means –
- Low – Under 100 mg or less than 3%
- Medium – 101-200 mg or 3-6%
- High – 201-200 mg or 6-9%
- Very High – Over 300mg or over 9%
Note – If Potassium chloride is in the ingredient list, it has high potassium content.
Prevention and strategic approach when you have or are prone for high blood potassium (Prevention of kidney disease or stabilizing kidney health)
Limit foods that are high in potassium levels – With the help of a good doctor, dietician, kidney doctor or nephrologists get a diet chart which mentions foods having high potassium. Identifying these foods help you to plan your diet and be careful that you are getting the right amount of potassium. Avoid French fries and other fried potatoes.
Choose low potassium foods – With the help of your dietician and or kidney doctor enlist the vegetables and fruits which have low potassium so that you can consume them. Also take their help to fix the portions of low potassium foods which can be safely consumed. Choose starches and vegetables that are lower in potassium such as rice, noodles, green beans etc.
Look at size of serving – All foods have some potassium, to varying levels. The size of serving off food matters a lot. A large amount of a low potassium food can turn into a high-potassium food.
Eat variety of foods – Take lot of varieties of foods but be careful and see that the foods you are taking are in moderation and not repetitive
Choose low-potassium vegetables – such as snow peas, string beans, water chestnuts, bean sprouts etc
Avoid tomatoes – Avoid tomatoes, tomato juice and sauce, also avoid Salsa verde (a green sauce made of green tomatoes)
Leach your vegetables – In case you are using potassium rich vegetables see that you leach them thoroughly before using. Check with your dietician regarding the amount of leached high potassium vegetables that can be safely consumed
Avoid canned juices – Avoid liquids from canned fruits and vegetables, or juices from cooked meat
Choose compatible restaurants – In case you are planning to eat outside, select such hotels and restaurants which are best suited to your diet or where you have the liberty to order the foods to be prepared in the way you want it to be. Call the restaurants well in advance and explain the authorities that you are following a special diet. Enquire about their menu and the procedure in which the food is prepared in their restaurant.
Avoid desserts having high potassium content – Avoid taking desserts with chocolate, ice cream, cream cheese or nuts in them. They are high in phosphorus and potassium.
- Chinese foods,
- Mexican Foods which generally are high-potassium foods
- Guacamole (made from avocados which are high in potassium)
- Beans and dried beans
- Black-eyed peas
- Cooked greens
- Sweet potato pie
Read – Read the food labels to find the best choice for your diet. A serving per container lists how many portions are there per container. Potassium is not required to be listed by law.
Caution at dialysis – If you are taking dialysis make sure to get all the treatment or exchanges prescribed to you
Normal Potassium intake per day
An average healthy individual (people with functioning kidneys) can take about 3500 – 4500 mg of Potassium per day. The quantity of intake can be altered or adjusted by the dietician after having analyzed the individual’s health in a comprehensive way. Nephrologists or kidney doctors can help you to modify your diet in order to prevent complications of kidney disease, if you have kidney disease. People with CKD (Chronic Kidney Disease) should consume less than that. Patients of CKD can take around 1,500-2,700 mg of potassium per day.
If you have CKD, you should get your potassium checked once a month.
What is meant by High Potassium levels?
In a diseased condition potassium levels more than 200 milligrams per portion food is considered as high potassium. The portion food or portion size should be taken as half cup unless specified otherwise. Below mentioned are the foods which have high potassium in them.
Potassium Rich Foods (potassium levels more than 200 milligrams per portion size of food, i.e. per half cup of food)
High Potassium Fruits
|Sl No||Name of the fruit||Portion size having high potassium|
|1||Apricot||Raw Apricot – 2 medium sized fruits|
Dried Apricot – 5 halves of the dried fruit
|2||Avocado||¼ whole fruit|
|3||Banana||½ whole fruit|
|5||Dates||5 whole fruits|
|7||Grapefruit||Juice of Grapefruit|
|9||Kiwi||1 medium sized fruit|
|10||Mango||1 medium sized fruit|
|11||Nectarine||1 medium sized fruit|
|12||Orange||1 medium sized fruit and Orange Juice|
|13||Papaya||½ whole fruit|
|14||Pomegranate||1 whole fruit and Pomegranate juice|
|15||Prunes||Fruit and Fruit Juice|
High Potassium Vegetables
|Sl No||Name of the Vegetable||Form of vegetable having high potassium content|
|7||Beets||Fresh then boiled|
|13||Dried Beans and Peas||Dried|
|14||Greens||All, except Kale|
|19||Mushrooms White||Half cup, cooked form|
|22||Potatoes||White and Sweet forms|
|26||Tomatoes||Tomatoes and all tomato products|
Other High Potassium Foods
|Sl No||Name of the food product||Portion in which high potassium content can be found|
|1||Bran||Bran and all Bran products|
|4||Milk||All types, 1 cup|
|5||Molasses||1 tablespoon quantity|
|6||Nutritional supplements||Should be used only under the direction of a qualified doctor or dietician|
|7||Nuts and Seeds||1 ounce|
|8||Peanut Butter||2 tablespoons|
|9||Salt substitutes||Lite Salt and other salts|
|10||Salt Free Broth||Salt Free|
|12||Snuff||Tobacco chewing and snuffing|
Low Potassium Foods (measured for half cup portion)
Note – Eating more than 1 portion of low potassium foods can make a lower potassium food into a higher potassium food. Therefore number of portions should be monitored. The below mentioned foods have low potassium and can be taken by those having kidney disease, in consultation with a doctor or dietician. The dietician or kidney doctor will decide and fix a safe portion of food for a given individual.
Low Potassium Fruits
|Sl No||Name of the Fruit||Form or portion of fruit having low potassium values|
|1||Apple||1 medium fruit, Apple Juice, Sauce|
|2||Apricots||Canned in juice|
|7||Cocktail||Made from fruits|
|11||Peaches||Fresh – 1 small fruit|
Canned – half cup
|12||Pears||Fresh – 1 small fruit|
Canned – half cup
|13||Pineapple||Fruit and fruit juice|
|18||Watermelon||Limited to 1 cup|
Low Potassium Vegetables
|Sl No||Name of the Vegetable||Form or portion having low quantity potassium|
|2||Asparagus||6 spears, raw|
|3||Beans||Green or Wax types|
|4||Broccoli||Raw or cooked from frozen broccoli|
|5||Cabbage||Green and Red varieties|
|9||Corn||Fresh – half ear|
Frozen – half cup
|15||White Mushrooms||Half cup|
Other Low Potassium Foods
|Sl No||Name of the Food||Form and portion having low potassium content|
|4||Bread||Bread and Bread products, not whole grain breads|
|5||Cake||Angel, Yellow varieties|
|6||Coffee||Limited to 8 ounces|
|7||Pies||Without chocolate or without including high potassium fruit as its ingredient|
|8||Cookies||Without nuts or chocolates|
|9||Tea||Limited to 16 ounces|
Based on this, the limits (portion) of low potassium fruits permissible for kidney disease patients are as mentioned below (changes from individual to individual, an average quantity is enlisted here) –
- Fresh Fruits – 1 small, ½ large
- Canned or frozen fruit – ½ cup juices, 4 oz
- Berries – 1 cup
- Grapes, Cherries – 12 numbers
- Dried fruits – ¼ cup
- Fats and oil, margarine – 1 teaspoon,
- Mayonnaise – 1 tablespoon
- Salad dressings – 2 tablespoons
- Sweet cookie – 1 cookie
- Ice cream, sorbet, gelatin – ½ cup
- Cake – 2 x 2 inches, 1 piece
- Fruit pie – 1/6 of 8 inch pie
- Sugar, jelly, jam – 1 tablespoon
- Nuts – ¼ cup
- Seeds – 1 oz
- Legumes – 2 tablespoon
- Dry beans, peas, cooked – ½ cup
- Peanut butter – 2 tablespoons
- Meats, poultry, fish – 1 oz cooked form
- Dairy product, milk substitute – 4 oz or ½ cup
- Egg – 1 egg or ¼ cup egg substitute
- Cheese – 1 oz
- Grains, cooked pasta, rice – 1/3 cup
- Cereal, cooked – ½ cup
- Bread – 1 slice
- Hamburger bun – ½ bun
- Vegetables cooked – ½ cup, raw vegetables – 1 medium or 1 cup cut up
- Juices – 4 oz or ½ cup
What is Leaching of Vegetables?
The patients with Kidney Disease have to take the vegetables as a part of their food. Many vegetables are removed from the equation due to their high potassium content. But if all vegetables are stopped, there would be not many options to consume vegetables. The best idea is to remove excess potassium from the vegetables so as to enable their consumption from patients of chronic kidney disease.
Leaching of Vegetables
Leaching of Vegetables is a procedure of removing excess potassium from some of the high-potassium vegetables. Leaching will remove excess potassium from the high-potassium vegetables but at the same time will ensure that it will not remove all potassium from the vegetables. Leaching of vegetables doesn’t assure that the food is safe enough to consume. The portion of vegetables of leached vegetables also should be determined. This means to tell that even leached high-potassium vegetables should be used within limitation. Help should be sought from dietician and or kidney doctor, for fixing the amount go leached vegetables which could be consumed safely.
Note – Not all potassium-rich foods can be leached
Canned foods and high potassium
Do not use canned fruits and vegetables; instead use fresh or frozen counterparts. The potassium in canned goods or foods leaches into the water or juice in the can. If you drink this juice it causes high potassium levels in the blood.
The juice in the cans usually has high salt content. This will cause the body to hold onto water. This can lead to complications with your kidneys. This is also true of meat juice. Therefore avoiding them is the best method.
If there is no other option but to have canned foods, drain the juice and discard it. Later rinse the canned food with water. This will reduce the amount of potassium to an extent.
How to leach the vegetables?
Potatoes, Sweet Potatoes, Carrots, Beets, Winter Squash and Rutabagas should be leached as below mentioned –
- Peel the vegetables
- Place the peeled vegetables in a vessel containing of sterile cold water. This prevents them from getting darkened.
- Make slices of the vegetables, each measuring approximately 1/8 inch thick
- Rinse the vegetables with warm water, for few seconds
- Soak the slices in warm water, for a minimum of 2 hours. The water should be ten times the quantity of the vegetables.
- If the idea is to soak longer, change the water once in every four hours
- Rinse under warm water again for few seconds
- After rinsing, cook the same vegetables with five times the amount of water (vegetables: water = 1:5)
The above said procedure is called Leaching of Vegetables
In short, the 6 steps of leaching as advised by National Kidney Foundation are as below mentioned –
- Peel the vegetable and place it in cold water so that it won’t darken
- Slice the vegetable into 1/8 inch thick parts
- Rinse it is warm water for a few seconds
- Soak the pieces for a minimum of two hours in warm water. Use 10 times the amount of water to the amount of vegetable. If you soak the vegetable for longer, be sure to change the water every four hours.
- Rinse the vegetable under warm water again for a few seconds.
- Cook the vegetable with five times the amount of water to the amount of vegetable.
It is important to check the potassium quantity in the foods to have a healthy potassium levels in the blood. At the same time one should not cut short the potassium from the diet totally since it is an essential nutrient for the body (as said earlier). Getting the balance is the key.
Just Before Finishing –
High Potassium in the blood is the greatest enemy for those having chronic kidney disease. To combat this condition either food in low potassium content should be included in the diet or leaching should be done to remove excess potassium from the foods. Leaching is a tedious procedure and plays on the nerves of the caretakers and attendants. But it is needed to protect the kidney health and overall health of the loved ones. In this article I have covered the details about Hyperkalemia (high blood potassium), the dietetic corrections needed to protect ones kidney and the procedure of leaching of vegetables.
Click to Consult Dr Raghuram Y.S. MD (Ayu)