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Patient Information Potassium lowering dietary advice The information contained within this diet sheet is intended to be used alongside the tailored dietary advice provided by your dietitian. Author: Dietetic & Nutrition Services Produced and designed by the Communications Team Issue date Jan 2016 - Review date Jan 2019 - Expiry date Jan 2020 Version 4 Ref no. PILCOM1693 Introduction Potassium lowering cooking tips Why do you need to follow a low potassium diet? The way we cook our foods, especially potatoes and vegetables, affects their potassium content. The process of boiling allows potassium to leak out of the food into the water and can therefore lower the potassium content of the food. Potassium is a mineral which is needed in the body for your muscles such as your heart to work properly. The amount of potassium in your blood is normally controlled by your kidneys; however when your kidneys aren’t working properly the amount of potassium in your blood can rise. For this reason you should: z Cut potatoes and vegetables into small pieces. High levels of potassium can be dangerous, as it can affect your heartbeat. To control your potassium levels in your blood you need to reduce the amount of potassium in your diet. z Peel potatoes before boiling. z Boil potatoes and vegetables in a large amount of water. After boiling throw the cooking water away - do not use this water to make soup, gravy, stocks or sauces. You should only follow a low potassium diet if you have been advised to do so by a qualified health professional and that you use this information in line with any other dietary advice you have received for example diabetes, low phosphate diet. z Once boiled potatoes and vegetables can then be roasted, mashed, fried or added to sauces. z Try to avoid potatoes and vegetables that have been steamed, microwaved, baked or fried unless they have been boiled first. 2 Carbohydrates (starchy foods) Carbohydrates, also known as starchy foods, provide energy, vitamins and fibre and should make up about a third of the food that you eat. Some starchy foods, such as bread, rice and pasta, are low in potassium and can be eaten freely. Others however such as potatoes, are high in potassium and need to be limited in the diet. Lower potassium alternatives Foods Reduce intake of Potatoes z Baked/jacket potatoes z Frozen/oven/microwave chips z Manufactured potato products, e.g.. hash browns, potato waffles, potato wedges, frozen roast potatoes z Steamed potatoes/ cassava/sweet potato/ yam/taro z Instant mashed potato couscous, pastry, Yorkshire puddings and dumplings are low in potassium z Cereals containing bran, dried fruits, nuts or chocolate such as: muesli, all bran, sultana bran, fruit and fibre, chocolate coated cereals Breads cassava/sweet potato/ yam/taro are boiled z The boiled potatoes can then be mashed, roasted, fried etc. z Up to 150g (5oz) potatoes (3 egg-sized potatoes) can be included daily z Pasta, rice, noodles, Rice, pasta and other grains Breakfast cereals z Ensure all potatoes/ z Cereals that are free from bran, dried fruit, nuts and chocolate such as Weetabix, Shredded Wheat, Shreddies, porridge, cornflakes, Rice Crispies, Cheerios z Breads containing nuts, z White, granary, wholemeal seeds or dried fruits z Naan bread (limit to half naan (80g) per day) breads and rolls z Pitta breads z Tortilla wraps z Bagels z Crumpets z English muffins z Croissants 3 Fruits and vegetables Fruits and vegetables provide us with a wide variety of vitamins and minerals, particularly vitamins B and C, and are a good source of fibre. However, many fruits and vegetables are also high in potassium. Therefore, it is important to choose the lower potassium varieties. Fruits (see table on page 5) It is important to eat no more than 2-3 portions of fruit containing low to moderate levels of potassium per day. A portion of fruit is 80g (3oz). This is equivalent to approximately a handful, e.g. 1 small apple, 2 heaped tablespoons of blueberries, 1 peach or 2 clementines. Vegetables (see table on page 6) It is important to eat no more than 2-3 portions of low to moderate vegetables per day. A portion of vegetables is 80g (3oz). This is equivalent to approximately 2 heaped tablespoons. 4 Low potassium Apple Blueberries Cherries (canned) Clementine Cranberries Fruit cocktail (canned) Fruit pie filling Gooseberries (stewed) Grapefruit* Guava (canned) Lemon Lime Loganberries (canned) Lychees Mandarins (canned) Mango (canned) Mixed peel Nectarine Oranges Papaya (canned) Passion fruit Peach Pear Pineapple (canned) Plums (canned) Pomelo Raspberries (canned) Rhubarb (canned) Satsuma Strawberries (canned) Tangerine Moderate potassium High potassium Apricot (canned) Blackberries Blackcurrants (canned) Cherries (fresh) Fig (fresh) Kumquats Mango Melon Papaya Peaches (canned) Pineapple (fresh) Plums (stewed) Pomegranate Quince Raspberries Strawberries Apricot (fresh) Blackcurrants (stewed) Damson Gooseberries (raw) Grapes Greengage Guava Kiwi Loganberries Physalis (cape gooseberry) Plums Prunes (canned) Redcurrants Rhubarb Sharon fruit Whitecurrants Very high potassium Apricot (dried) Avocado Banana Blackcurrants (raw) Coconut Currants (dried) Dates Dried fruit mix Fig (dried) Prunes (dried) Raisins Sultanas Star fruit can cause dangerous side effects in people with kidney problems. Therefore, it is recommended you avoid them. * You may be advised not to have grapefruit if you are taking certain medications. Please check with your doctor if you are unsure. 5 Low potassium Beansprouts (raw) Cabbage (boiled) Carrots (boiled) Cauliflower (boiled) Chickpeas (canned) Corn on the cob (boiled) Cucumber (raw) Gherkins (pickled) Green/French beans (canned) Leeks (boiled) Marrow (boiled) Mixed vegetables (frozen) Mushrooms (canned) Mustard and cress (raw) Olives (canned/ jar) Onions (boiled or pickled) Sugar snap peas (raw/boiled/stirfried) Peas (frozen or canned) Pepper (red or green raw) Pumpkin (boiled) Runner beans (boiled) Squash spaghetti type (boiled) Swede (boiled) Water chestnuts (canned) Moderate potassium High potassium Asparagus (boiled) Aubergine (fried) Beetroot (pickled) Broad beans (fresh/canned/ boiled) Broccoli (boiled) Carrots (raw) Celery (boiled) Chicory (raw) Coleslaw (raw) Courgette (boiled) Curly kale (boiled) Green/French beans (boiled) Kohlrabi (boiled) Lentils red (boiled) Lettuce (raw) Mange tout (boiled/raw/fried) Mixed vegetables (canned) Mooli (raw) Onions (raw) Peas (mushy) Pepper (yellow raw) Potato salad Radish (raw) Salsify (boiled) Shallots ((raw) Spinach (boiled) Spring greens (boiled) Squash (all summer ones boiled) Sweetcorn (baby/ canned/frozen) Tomato (canned) Turnip (boiled) Watercress (raw) Artichoke (boiled) Baked beans Blackeye beans (boiled) Brussels sprouts (boiled) Butter beans (canned) Butternut squash (baked) Cabbage (raw) Celeriac (boiled) Celery (raw) Chickpeas (dried) Chilli beans (canned) Courgette (raw) Fennel (boiled) Kidney beans (canned) Lentils green/ brown (boiled) Mung beans (boiled) Mushrooms (raw/ fried) Okra (boiled) Onions (fried) Parsnips (boiled) Split peas Radicchio (raw) Spinach (frozen then boiled) Spring onions Tomato (raw) 6 Very high potassium Aduki beans Artichoke Bamboo shoots (canned) Beetroot (fresh) Chard, Swiss Endive Mushrooms (dried) Pak choi Pinto beans Soya beans Spinach (raw) Tomato puree Sun-dried tomatoes Milk and dairy products Milk and dairy products provide essential nutrients such as calcium, which is needed for healthy bones and teeth, and protein, which is needed for growth and repair of tissues. However, milk is high in potassium and needs to be limited. Foods Reduce intake of: Lower potassium alternatives Milk z Milk should be limited to z Oat or rice milk can be half a pint (300ml) of milk per day. This includes cow, sheep, goat and soya milk. Dairy based products z These foods must be included within the allowance of half a pint of milk per day. z The following should be considered equal to 200mls of milk: - A small pot of yogurt (125g) - A bowl of rice pudding (200g) z The following should be considered equal to 100mls of milk: - 2 tablespoons of Greek yogurt - 2 tablespoons of custard - 2 scoops of ice cream - 1 small pot of crème caramel 7 used as an alternative and can be drunk freely. z Crème fraiche z All types of cheese. However, it is important to remember cheese is high in phosphate. z All types of cream. Meat, fish and alternatives This food group is the main source of protein in our diet. Protein is important for growth and continuous replacement of body tissue, including building and maintaining muscles. They also provide us with a variety of vitamins and minerals Foods Lower potassium alternatives Reduce intake of: z Nuts z Seeds z Meat and poultry - all types z Fish and seafood - all types z Eggs z Quorn z Tofu Pulses, such as boiled chickpeas or red lentils, can be included as a source of protein to replace meat or fish as a vegetarian meal. However, it is important to choose the pulses that are low to moderate in potassium, as per the recommendations for fruit and vegetables (see pages 4-6). 8 Snacks and desserts If you have been advised to follow a diet low in salt or sugar, some of these foods may not be suitable. Please speak to your dietitian if you are unsure. Lower potassium alternatives Foods Reduce intake of: Savoury snacks z Potato-based crisps z Vegetable crisps z Nuts and dried fruit/seeds z Bombay mix z Twiglets z Maize/corn-based snacks, Biscuits and cakes z All cakes, biscuits or z Rich tea, digestive, ginger Confectionery z Chocolate z Toffee z Fudge z Confectionery containing cereal bars that contain dried fruit, nuts or chocolate dried fruit or nuts z Liquorice Puddings z All puddings containing dried fruit, nuts or chocolate 9 e.g.. cheese puffs, tortilla chips z Rice-based snacks, e.g. Snack a Jacks, rice cakes z Bread sticks z Plain crackers z Popcorn z Pretzels biscuits, shortbread z Cream/jam filled biscuits z Wafers z Sponge cake z Doughnuts z Swiss roll z Jam tarts z z z z z Boiled sweets Chewy sweets Jelly sweets Mints Marshmallows z Fruit pie/crumble z Cheesecake z Meringue Drinks and alcohol It is important that you ensure your intake is within your fluid allowance and that you follow your medical team’s advice regarding alcohol intake. Drink Reduce intake of: Non-alcoholic drinks z Fruit juices z Hi juice squashes z Fruit or vegetable smoothies z Coffee z Drinking chocolate/cocoa z Malted drinks, e.g. Horlicks/Ovaltine Alcohol z z z z Beer/lager Cider Stout Wine/champagne/ sparkling wine z Sherry z Port 10 Lower potassium alternatives z Water z Tonic water z Soda water z Flavoured water z Cordials, squash z Barley water z Energy drinks, e.g. Red Bull, Relentless z Fizzy drinks, e.g. lemonade z Tea - all types z Camp or Barley Cup coffee z Spirits, e.g. rum, whiskey, vodka, brandy, gin Miscellaneous foods Foods Reduce intake of: Miscellaneous z Tomato puree z Soup z Tomato ketchup z Brown sauce z Marmite/Bovril/Vegemite z Black treacle z Peanut butter z Chocolate spread z Salt substitutes* Lower potassium alternatives z Herbs and spices z Pepper z Garlic z Vinegar z Mustard z Pickle z Mayonnaise/salad cream z Horseradish sauce z Mint sauce z Apple sauce z Gravy granules z Curry powder z Golden syrup z Honey z Lemon curd z Jam z Marmalade * Salt substitutes such as Lo-salt, So-Lo and low sodium salt contain potassium instead of sodium and therefore should be avoided. 11 Not to be photocopied Individual goals Contact details: If you require further information, please contact the Nutrition and Dietetic Department at Basildon University Hospital on 01268 593958. All dietitians employed at Basildon and Thurrock University Hospitals NHS Foundation Trust are state registered with the Health and Care Professionals Council. Basildon University Hospital Nethermayne Basildon Essex SS16 5NL 01268 524900 Minicom 01268 593190 Patient Advice and Liaison Service (PALS) 01268 394440 E [email protected] W www.basildonandthurrock.nhs.uk The Trust will not tolerate aggression, intimidation or violence directed towards its staff. This is a smokefree Trust. Smoking is not allowed in any of our hospital buildings or grounds. This information can be provided in a different language or format (for example, large print or audio version) on request.