Balancing Diet and Medications to Treat Hyperkalemia

When you have hyperkalemia, you have too much potassium in your blood. You can lower your potassium levels with diet, medicine, or both.

What Your Doctor May Recommend

Your doctor or health care provider will help you create a treatment plan that’s right for you.

You may need to follow a diet that’s low in potassium. You may need medication that helps take extra potassium out of your body and keep it from coming back. Or you may need both.

“An individualized approach is best,” says Ankur Shah, MD, a nephrologist at Brown University’s Warren Alpert Medical School in Providence, RI. Everyone’s different, so you may have unique potassium level goals. Your health care provider will decide what’s best for you and make changes as you go along.

A good plan may depend on things like:

• How serious your hyperkalemia is
• Your medical history
• Your current potassium levels
• Your current medications
• How much potassium is in your regular diet
• Medication costs vs. benefits
• How well you can manage diet changes

Diet Changes to Manage Hyperkalemia

Making changes to your diet can help you control hyperkalemia.

Your doctor may recommend a low-potassium diet, especially if you get too much potassium from what you normally eat.

They may tell you to limit certain fruits and vegetables, milk and yogurt, nuts and seeds, and other foods like bran, chocolate, granola, and peanut butter.

But you may need high-potassium foods to help you stay healthy.

Foods like meat, fish, and chicken, which have a lot of potassium, are also high in protein, which is an important part of your diet. “High-potassium foods like fruits, vegetables, nuts, and legumes contain nutrients such as vitamins, minerals, and fiber, which have many health benefits,” says Edith Yang, a registered dietitian nutritionist in Monrovia, CA, who specializes in chronic kidney disease.

Having too little potassium isn’t good either. If your potassium is too low, it may lead to problems like abnormal heart rhythm, muscle weakness, and paralysis.

“Find the right balance by making sure to include an adequate amount of vegetables on your plate, aiming to eat a rainbow, keeping track of your labs, and working closely with a registered dietitian that specializes in chronic kidney disease,” Yang says.

Try these strategies:

Balance your plate. “Make half of your plate veggies, one-fourth protein, and one-fourth carbohydrate,” Yang says. These numbers may need to be adjusted based on how serious your hyperkalemia is, but it’s a good starting point.

Eat a variety of foods. “A wide variety of whole grains, fruits, and vegetables helps ensure you’re getting adequate nutrition,” Yang says.

Control your portion size. By limiting your portions, you can get the potassium you need without going overboard. Eat in moderation and watch your serving size.

Drain or leach certain foods. If you eat canned fruits, vegetables, or meats, drain them first. If you eat high-potassium fresh vegetables, try leaching them first. Peel and place them in cold water. Next, slice them into thin pieces and rinse them in warm water. Then soak them in warm water for 2 or more hours, rinse them again in warm water, and cook them with extra water.

Avoid certain herbal supplements. “Be careful of any supplements that may have potassium added,” Yang says. Let your doctor know if you start taking a new supplement or medication. Avoid salt substitutes, which are high in potassium.

Your doctor or dietitian can help create a meal plan and adjust it based on how it works for you.

Medication for Hyperkalemia

You may need medication to help lower your potassium levels.

There are different types of medications. Some lower your potassium quickly, while others do it over time.

Common treatments for hyperkalemia include:

Diuretics. When you take diuretics, your kidneys make more urine, which removes potassium. As you urinate more, your body gets rid of more potassium. Diuretics are also known as water pills.

Potassium binders. This medication binds to extra potassium in your bowels, then removes it when you empty your bowels. A potassium binder may be a powder you mix with water and drink with a meal, or an enema, which goes into your rectum.

Changes to your current medications. Certain drugs, like blood pressure medications and immunosuppressants, may lead to high potassium. Your doctor may recommend stopping or changing your medication to lower your potassium levels.

If your potassium level is very high and these don’t help, your doctor may recommend other treatments. “Patients with severe hyperkalemia or who aren’t urinating are more likely to need IV therapies or dialysis,” says Shah. If you have kidney failure, you’ll likely need dialysis.

How to Find the Right Balance

Your doctor will decide what potassium level to aim for and what strategies may be best for you.

Your doctor will monitor you to see how well your diet changes and medication are working. They’ll check your lab results regularly to make sure you’re not getting too much or too little potassium. They’ll also ask you how you feel.

If you don’t feel well or you feel like you’re not striking a good balance between diet and medicine, talk to your provider about making changes.