How to lower your potassium for heart failure patients

Potassium is a mineral found in most types of food.

It has many important uses in the body.

• A normal potassium level is usually 3.5 - 5.3 millimoles per litre (mmol/L).
• If you have reduced left ventricular function, normal potassium range is 3.9 - 5.3 millimoles per litre (mmol/L).

The most common reason for potassium being out of range is that your kidneys are not working properly. The kidneys usually control the level of potassium in your blood and prevent it from becoming too low or high.

Medications can also affect potassium level including some medications used to treat heart failure. Medications such as Entresto, Ramipril, Candesartan, Spironolactone can all cause an increase in potassium levels.

If you are unsure why your potassium level is abnormal, you can discuss this with the Heart Failure Team.

A potassium level that is too high can cause problems with your heart such as cardiac arrhythmia (irregular heart rhythm) and in some cases, could cause a cardiac arrest (heart stops beating). Patients with heart failure are at a higher risk of these happening, so it is important your potassium level is kept in range.

Potassium level is checked by blood tests. If your potassium level is out of the normal range, we may do blood tests more often to monitor this.

Low Potassium

To choose:

• Tinned mandarin
• Tinned oranges
• Tinned peaches
• Tinned pears
• Tinned pineapple
• Tinned raspberries

Medium potassium

These should be limited to an 80g portion:

• Apple (1 medium)
• Blackberries (1 handful)
• Blueberries (1 handful)
• Cherries (1 handful)
• Clementine (2 small)
• Fruit cocktail, tinned (a third of a tin)
• Gooseberries, stewed (2 tablespoons)
• Grapefruit (half a medium grapefruit) - this should be avoided with certain medications. Please speak to the Heart Failure Team to find out what you should do
• Grapes (15 small)
• Kiwi (1)
• Lemon (1)
• Mango (2 thin slices)
• Melon; cantaloupe, Galia or Honeydew (1 slice of melon that has been cut into 6)
• Orange, flesh only (half a medium orange)
• Passionfruit (1)
• Peach (1 medium)
• Pear (1 small)
• Pineapple (1 large slice)
• Plum (2 small)
• Pomegranate (half a small pomegranate)
• Raspberries (1 handful)
• Satsuma (2 small)
• Sharon fruit (half)
• Strawberries (7)
• Tangerine (2 small)

Medium to high potassium

To be limited to smaller portion sizes as specified:

• Blackcurrants (1 small handful)
• Prunes, stewed (4)
• Rhubard, stewed (2 level tablespoons)

To avoid:

• Avocado
• Banana
• Coconut
• Rhubarb, raw
• Dried or freeze-dried fruit including apricots, dates, figs, raisins, prunes, sultanas and currants

Vegetables should be boiled in plenty of water until they are soft (for at least 10 minutes). Boiling allows some of the potassium to be removed from the vegetable and into the water. This water should be thrown away and not used for gravy or stock. Some vegetables can be eaten raw or fried, which is stated in the list below.

Low potassium

The following vegetables are low or medium potassium, and should be limited to an 80g portion and boiled unless otherwise stated:

• Aubergine, baked (a quarter)
• Beetroot, pickled (2 small beet)
• Beansprouts, fried
• Broccoli (2 spears)
• Cabbage (2 tablespoons)
• Carrots, raw (2 tablespoons)
• Cauliflower (2 florets)
• Coleslaw, raw (2 tablespoons)
• Courgette ( a third of full length)
• Cucumber, raw (10 thin slices)
• Garden peas (2 tablespoons)
• Green beans, tinned (2 tablespoons)
• Leek (1 small)
• Lettuce, raw (1 handful)
• Mangetout, fried or boiled (2 tablespoons)
• Mixed vegetables (2 tablespoons)
• Mushy peas, tinned and re-heated (2 tablespoons)
• Onions, pickled (5)
• Onion, raw (1 small)
• Pepper, raw (half medium)
• Sweetcorn, tinned and re-heated (2 tablespoons)
• Tomato, raw (1 small)

Medium to high potassium

These should be limited to smaller portion sizes and boiled unless otherwise stated:

• Asparagus (3 spears)
• Baked beans, tinned and re-heated (1 tablespoon)
• Beetroot (2 slices)
• Brussel sprouts (5)
• Celery, raw (1 stick)
• Cherry tomatoes, raw (4)
• Green or French beans (2 tablespoons)
• Mushrooms, raw (5 small)
• Parsnip (1 tablespoon)
• Spinach, frozen then boiled (1 tablespoon)
• Spring onions, raw (4)
• Tinned tomato, with the juice drained off (a quarter of a tin)

High potassium

These should be avoided:

• Fresh spinach
• Okra
• Soya (Edamame) beans

Some cereals, breads, noodles, pre-made chapatti, wraps and bagel varieties have potassium added as a preservative. We advise to avoid foods where potassium appears on the ingredients list. Where possible, try to choose fresh products from a bakery, or make your own.

Low potassium

To choose:

• White bread, rolls, breadcakes and plain bagels
• Pasta
• Rice
• Couscous
• Rice noodles
• Cereals made from corn, oats, puffed wheat and rice for example: Cornflakes, porridge, Rice Krispies, Special K.

Medium potassium

To be eaten in controlled amounts with the portion size stated below:

• Brown or wholemeal bread (2 slices)
• Cereals made from whole grain wheat for example: Weetabix (2 biscuits), Shredded Wheat (2 biscuits)
• Potatoes (including sweet potato) must be peeled and boiled until they are soft and limited to 3 egg sized portions each day. Boiling allows some of the potassium to be removed from the potato and into the water. This water should be thrown away and not used for gravy or stock.

High potassium

To avoid:

• Baked potato
• Chips (including frozen, oven, microwave and shop-bought varieties)
• Manufactured potato products (including potato croquettes, potato waffles, hash browns, wedges), instant mashed potato
• Steamed potatoes
• Breads containing nuts, dried fruit, chocolate, coconut, potato or seeds, for example: Peshwari naan, fruit loaf, potato cakes
• Quinoa
• Cereals containing bran, dried fruit, nuts, chocolate, for example: All Bran, Museli, Sultana Bran.

Low potassium

• Meat (all types)
• Poultry (all types)
• Fish and seafood
• Eggs

The following vegetarian based protein sources can replace the meat, poultry or fish within your main meal:

• 150g Quorn pieces, soy protein or fried tofu
• Red kidney beans (3 tablespoons)
• Haricot beans (3 tablespoons)
• Chickpeas (4 tablespoons)
• Butter beans (4 tablespoons)
• Cannellini beans (4 tablespoons)
• Lentils (4 tablespoons). Tinned lentils and beans tend to be lower in potassium compared to dried.

High potassium

• Nuts
• Seeds

Low potassium

• Cream, creme fraiche
• Unfortified oat, rice or soya milk

Medium potassium

• Cows, goat and sheep milk (limit to a third of a pint per day)
• Custard
• Rice pudding
• Ice cream
• Yogurts

High potassium

• Coconut milk
• Creamed coconut
• Condensed milk
• Evaporated milk
• Dried milk powder

Some companies and supermarket own brands have started to add potassium chloride (KCl) to some potato and non-potato snacks. It will be listed in the ingredients list. Please check and choose snacks without added potassium chloride.

Low potassium

To choose:

• Corn and rice or wheat-based snacks (for example popcorn, tortilla chips, bread sticks, cream crackers, Mini Cheddars, pretzels)
• Crisp breads
• Crackers

High potassium

To avoid:

• Bombay mix
• Nuts or seeds
• Potato, vegetable, lentil or quinoa crisps

Below are some options for sweet snacks. If you have diabetes, it is recommended that you limit your intake of sugary food. Therefore, some of the suggestions made in this table below may not be appropriate for you.

Low potassium

To choose:

• Biscuits; plain, wafer, jam or cream biscuits
• Cakes; plain, cream, jam filled or iced cakes
• Doughnut
• Fruit pie or crumble
• Pavlova
• Cheesecake
• Plain scone
• Boiled sweets
• Marshmallow
• Mints
• Toffee

High potassium

To avoid:

• Liquorice
• Nut brittle
• Chocolate
• Marzipan
• Any biscuits, cakes or sweets containing nuts, chocolate, dried fruit, coconut, nuts.

Low potassium

To choose:

• Diluted fruit squash or cordial
• Fizzy drinks, for example lemonade
• Mineral water
• Tea

High potassium

To avoid:

• Bovril or Jardox
• Coconut water
• Coffee (limit to 1 cup per day)
• Hot chocolate, cocoa powder
• Fruit and vegetable juices or smoothies
• Malted instant drinks for example Horlicks or Ovaltine

Low potassium

To choose:

• Liqueurs
• Shandy
• Sherry
• Spirits
• Vermouth

Medium potassium

To limit:

• Bitter, brown ale, lager (limit to half a pint at a time)
• Wine (limit to 1 small glass (125ml) at a time)

High potassium

To avoid:

• Cider
• Port
• Stout
• Strong ales

Low potassium

To choose:

• Apple sauce
• Chilli sauce
• Curry powder
• Gravy granules or stock cubes
• Herbs, spices
• Garlic
• Pepper
• Honey
• Golden syrup
• Jam
• Marmalade
• Lemon curd
• Pickles
• Piccalilli
• Mint sauce
• Mustard
• Mayonnaise
• Salad cream
• Vinegar

High potassium

To avoid:

• Black treacle
• Chocolate spread
• Nut butters e.g. peanut butter
• Salt substitutes and meals containing these e.g. Lo Salt or Saxo low sodium
• Tahini
• Tomato ketchup, tomato puree or passata
• Yeast extract e.g. marmite or vegemite

Community Heart Failure Team

01709 423257
9am to 5pm, Monday to Friday
Please leave a message on the answerphone and a member of the team will call you back. Messages may not be picked up until the next working day.