Potassium Guidelines for Patients with Heart Failure - Nutrition

This guide provides basic information to help you start regulating your potassium level until your appointment with a registered dietitian, who is a nutrition expert. These are general guidelines that may be tailored to meet your needs. Please talk to your health care provider to make sure that these guidelines apply to you.

Often, certain diuretics cause loss of potassium and so we encourage high dietary potassium intake. On the other hand, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and aldosterone inhibitors increase potassium levels and you may need to decrease this electrolyte in your diet.

Eating healthy often means making changes in your current eating habits. A registered dietitian can provide in-depth personalized nutrition education to help you develop a personal action plan.

Potassium and your diet

Potassium is a very important mineral that is necessary for normal body growth and for building muscle. It helps the body balance acid and water in the blood and body tissues, and it helps to break down amino acids and carbohydrates.

A normal potassium level is between 3.5 and 5.0 mEq/L (milliequivalents per liter of blood serum). An excess of potassium in your blood (hyperkalemia) can have serious side effects and should be treated immediately. Side effects include weakness, general discomfort, nausea, diarrhea, pain and muscle weakness. These side effects can progress to paralysis, a decreased ability to urinate and a slow or irregular heartbeat.

The kidneys usually excrete nearly all the potassium that is taken in. Because you have heart failure, your kidneys are no longer working as well. Therefore, you need to regulate potassium in your diet.

Tips to lower potassium

• Review the dietary guidelines and potassium source guide on the following pages and limit high-potassium foods in your diet.
• Soak or boil vegetables and fruits in water to help reduce the potassium content.
• Look on labels for symbols listed as KCl, K+ or potassium and avoid these foods.
• Potassium may be used in some foods as a preservative or a salt substitute.
• These foods are high in potassium and should be avoided: salt substitutes listed as KCl on labels, Ovaltine, light salts, coffee, sport drinks, granola bars, molasses, chocolate and fig cookies.
• Keep a food journal to review with your dietitian.

Low sodium/low potassium dietary guidelines - Meat and meat alternatives

* Choose 6-7 servings per day. One serving contains 8 g of protein, 50 mg of sodium, 120 mg of potassium and 0 g of carbohydrate

General guidelines

Meat may be cooked in any manner. Weigh meat, fish, and poultry after cooking, without bones or visible fat.

Notes* Ask butcher to slice fresh side of pork in strips like bacon
** Less than 50 mg sodium and 150 mg potassium per oz))

Avoid

• Canned, salted, pickled, corned, spiced or smoked meats and fish such as: anchovies, beef or pork bacon (except unsalted), caviar, corned beef, dried beef, ham, all hot dogs, luncheon meats, sandwich spreads, salt pork and sausage
• Commercially prepared canned or frozen dinners such as: Chinese food, macaroni and cheese, spaghetti, pot pies, stews, TV dinners, meat entrees, breaded fish and meats, fish sticks and fried chicken
• Meats or casseroles in salted or sweet sauces
• Meat extenders made of textured soy or vegetable protein (high protein ground beef, imitation bacon bits, imitation meat products or frozen meat entrees containing soy or vegetable protein)
• Dried beans, legumes and peas; soybeans
• Sunflower seeds and nuts
• Regular cheese

Low sodium/low potassium dietary guidelines - Fruit

*Choose 3 servings per day - One serving contains 1 g of protein, 5 mg of sodium, 155 mg of potassium and 10 g of carbohydrate

General guidelines

Use fresh or unsweetened canned or frozen fruit and juices. Juice-packed fruit should be drained; the juice can be used as one serving of fruit juice.

Notes* Other juices include grape, apricot or peach nectar or pineapple juice. Count as part of your daily fluid allowance.
** Other berries include blueberries, boysenberries, raspberries and strawberries.
***Other juices include orange, prune and tangerine juice. Count as part of your daily fluid allowance. One tbsp of lemon or lime juice can be used daily without counting it as fruit in your meal plan.

Use caution with these high-potassium fruits

• Bananas
• Strawberries
• Oranges and other citrus fruits
• Avocados

Avoid

• Avocado, olives and dried fruits not listed above
• Sweetened, canned and frozen fruits and juices

Low sodium/low potassium dietary guidelines - Milk and dairy products

* Choose 2 servings per day - One serving contains 4 g of protein, 60 mg of sodium, 175 mg of potassium and 6 g of carbohydrate

General guidelines

Count each serving as part of your daily fluid allowance. You may substitute one-half meat serving for one milk serving, but DO NOT substitute milk for meat.

Avoid

• Soy milk or milk products
• Instant breakfast drinks

Low sodium/low potassium dietary guidelines - Vegetables

* Choose 2 servings per day

One serving contains 1 g of protein, 5 mg of sodium, 155 mg of potassium and 5 g of carbohydrate

General guidelines

Use fresh vegetables, frozen vegetables without salt or unsalted canned vegetables. To reduce the potassium in cooked vegetables, cook in a large amount of unsalted water, drain and discard the water.

Notes: *A small amount of celery, onion or green pepper (less than 2 tbsp a day) can be used in cooking without counting it as a vegetable in your meal plan.
**Potato should be boiled or mashed, specially prepared, only once a day
***Tomato juice should be unsalted, containing no potassium preservative. Count as part of your daily fluid allowance.

Up to 3 slices of low-sodium pickle chips may be used each day without counting in your meal plan.

Avoid

• Baked potatoes
• Baked acorn squash or butternut squash
• Dried peas or beans, lentils, lima beans, chick peas or garbanzo beans, baked beans or any other beans or peas not listed above
• Olives, sauerkraut and regular pickles
• Pumpkin seeds
• Vegetable juice cocktail
• Vegetables prepared in sweetened or salted sauces
• Stews and vegetable soups unless the vegetables have first been diced, cooked in a large amount of water and then drained

Potassium Source Guide

Breads and Grains

• Low potassium
  • plain bagel
  • white bread
  • oatmeal
  • plain pasta
  • white rice
• Moderate potassium
  • bran bread
  • muffins and cereals
  • whole wheat and pumpernickel bread
  • rolls
  • crackers
  • corn tortilla
  • oat and granola cereals

Fruits and Vegetables

• Low potassium
  • blueberries
  • grapes
  • grapefruit
  • strawberries
  • green beans
  • cauliflower
  • cucumbers
  • lettuce
• Moderate potassium
  • apple
  • cherries
  • pear
  • apricot
  • pineapple juice
  • peaches
  • carrots
  • peppers
  • eggplant
  • pumpkin
  • radishes
  • asparagus
  • corn
• High potassium
  • bananas
  • orange
  • kiwi
  • nectarine
  • dried fruits
  • papaya
  • prune
  • avocado
  • apricots
  • coconut
  • potato
  • broccoli
  • spinach
  • tomato
  • artichokes
  • greens
  • winter squash
  • yams
  • plaintains
  • prune juice

Dairy

• Low potassium
  • sour cream
• High potassium
  • milk and yogurt

Meat, Fish, Poultry

• High potassium
  • beef
  • poultry
  • pork
  • veal
  • fish
  • eggs
  • peanut butter
• High potassium
  • pinto bean
  • soy products
  • dried beans and peas
  • nuts
  • imitation bacon bits

Potassium-free Choices

• Kool-Aid
• fruit punches
• jelly beans
• non-dairy topping
• non-dairy creamers

This handout provides general guidelines for moderating potassium. The next step is to make an appointment with a registered dietitian, the nutrition expert. A registered dietitian will evaluate different health factors to determine your individual nutritional status, review your diet history, explain product selection, label reading, cooking methods, menu planning, dining out and develop an individualized treatment that will meet your needs.

If you need more information on heart failure, contact us , chat online with a nurse or call the Miller Family Heart & Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

For Nutrition Information:

For more information on a heart-healthy diet plan, please contact :

• Preventive Cardiology and Rehabilitation Program at 216.444.9353 (or toll-free at 800.223.2273, extension 4-9353) and we can schedule a nutrition consultation - or - use our Remote Cardiac Nutrition Counseling Services.
• Nutrition therapy - 216.444.3046 or 800.CCF.CARES ext. 4-3046

Additional Resources:

• American Dietetic Association*
• American Heart Association*
• Food and Drug Administration*

* The inclusion of links to other web sites does not imply any endorsement of the material on the web sites or any association with their operators

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/06