A Guide to a Low potassium diet – incorporating African and Caribbean foods

Dietitian:

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Introduction

The dietary advice in this booklet has been developed by experienced renal dietitians with the support of patients

What is potassium?Potassium is a mineral that is found naturally in many foods. Some potassium is needed as part of a healthy diet. It is required to ensure healthy working of muscles, including the heart .

Your potassium level should be 3.5 – 5.5mmol/l (3.5 – 6.0mmol/l if on haemodialysis)Why do I need to control the amount of potassium in my blood?Too much potassium in your blood can be dangerous as it affects the rhythm of your heart and can cause the heart to stop beating.

Why is the level of potassium in my blood too high?The level of potassium in your blood is usually controlled by the kidneys. When your kidneys are not working properly, the potassium level in your blood may rise. It is quite common for people with kidney problems to have too much potassium in the blood..

Can I tell if my potassium is high?There are usually no symptoms to indicate if your potassium is high and the most reliable way to tell is by having a blood test.

What should I do to control my blood potassium levels?You can control your potassium levels by:

Following a low potassium diet Ensuring regular bowel habits as you lose some potassium in the stool If you are diabetic, ensuring good blood sugar control If you are on dialysis, keeping to your scheduled sessions

Will the low potassium diet include healthy eating advice?

This resource only focuses on a low potassium diet. We have aimed to include low potassium foods that are suitable swaps for foods commonly eaten, e.g. doughnut can replace fruit cake. For this reason, some of the foods in the low potassium section may be high in sugar, salt or fat. Please take into consideration any other diet you may be following when making choices from the suitable/low potassium columns. If there are any questions, please discuss with your renal dietitian

Carbohydrate

Carbohydrates, also known as starchy foods, provide energy, vitamins and fibre. You should try to include something starchy at each meal to provide you with energy.

Examples of carbohydrates:

Rice, pasta and other grains for example semolina, corn Potato, sweet potato, cassava and yam Breakfast cereals, pap Breads

Starchy root vegetables including tubers and ground provisions

Choose up to one boiled 150g serving per day

Limit

Breadfruit

Baked/fried/roasted/steamed/pressure cooked breadfruit/cassava/plantain/potatoes/sweet potatoes/taro/yam

Cassava Frozen/oven/retail chips

Plantain/green banana -100g only Instant mash

Potatoes Potato products- potato waffles, hash browns, wedges, croquettes

Sweet potato

Taro/dasheen

Yam

Some starchy root vegetables like potato, sweet potato, cassava and yam are particularly high in potassium and need to be limited in the diet (choose up to one serving per day- see table below). Other starchy foods based on wheat or rice are low in potassium and are good alternatives to choose.

If you do not routinely include high potassium starchy vegetables in your diet, you may be able to allow for a higher intake of potassium elsewhere in your diet. Your dietitian can discuss this with you on an individual basis.

If you are having foods made with these ingredients, e.g. plantain fufu or amala made with cassava/gari please include them in the allowance above.

Cooking instructions for starchy root vegetables The starchy root vegetables in the table above should be boiled in water to lower

their potassium content. Discard the water after boiling and do not use for stock, soups, dhals and sauces.

The skins on potatoes provide a good source of fibre and B vitamins. However, if your potassium levels are often high, peel your potatoes and cut into small pieces before boiling, as this helps to remove more potassium.

Baking, frying, roasting, and steaming potatoes, tubers, ground provisions and vegetables does not reduce potassium. Pre-boiling helps to remove some potassium before cooking this way.

Microwaving is only suitable for reheating starchy root vegetables that have previously been boiled.

Rice, pasta and other grajns

Rice, semolina, pasta, cornflour and other grains can be eaten freely.

Low HighAbolo (made with rice or maize) Quinoa

Cornmeal Plantain- steamed/baked/friedCouscous Dasheen- Steamed/fried/bakedKenkey millet grains Breadfruit- Steamed/fried/baked

Rice/rice flour/tuwo masa/tuwo shinkafa Yam- Steamed/fried/baked

Semolina/Semovita fufu Steamed/fried/baked cassavaUgali Millet flour

CerealsBranflakes Cereals with dried fruit/nuts/chocolateCocopopsCornflakes/Kooko/Tombrown/Akamu

OgiPap/MielepapPorridgeRice KrispiesShredded wheatShreddies

Breakfast cereals Cereals made from wheat, oats, corn, rice and corn are lower in potassium and may be eaten

regularly. Cereals containing bran, dried fruits, nuts and chocolate are higher in potassium and should be

limited. Milk and yoghurt added to cereals should be counted within your dairy allowance (see dairy

section). If you have diabetes please choose lower sugar containing breakfast cereals.

Breads

Bread, rolls, crackers and pitta breads without nuts and seeds may be eaten regularly.Bread and crackers containing nuts, seeds, coconut, dried fruits and chocolate are high in potassium and should be limited.

Fruit and Vegetables

Fruit and vegetables are a good source of vitamins, minerals and fibre and form a large part of a healthy balanced diet. The potassium content of all fruits and vegetables varies and these are listed in the table below as low, medium, high and very high.

Aim for a total of 4-5 portions of fruit and vegetables daily or as advised by your dietitian.

Choose most of your choices fruits and vegetables from the low or medium columns. If choosing from the high column, you may need to reduce the number of fruit and vegetable portions you have that day. Fruit and vegetables listed as having a very high potassium content should be avoided.

All vegetables should be boiled, rather than steamed or microwaved. Boiling allows some of the potassium to leach into the water which should be thrown away and not used for gravy or stock.

Canned fruit and vegetables should be drained before eating.

Vegetables and salad

A portion of vegetables is 80g and boiled unless otherwise stated in the table below. If one portion of vegetables is not taken, then you can swap for a portion of fruit or a handful of salad.

Low <3mmols/80g Medium (3-5mmols/80g)

High (5-7mmols/80g)

Avoid (>7mmols/80g)

Beansprouts- raw or cooked 4 tbsp Cabbage 2tblp raw Ackee -canned Amaranth -raw

Aubergine - fried/baked

AmaranthAvocado

Cabbage Broccoli 2 florets-

Asparagus - 3 spears raw/fried (tough base removed

Baby spinach –boiled or raw

Cauliflower -3 florets Carrots 1 medium- Brussel sprouts cassava leaves -raw

Cucumber raw Celery raw 1 stick Karela/bitter gourd

cocoyam leaf (Xanthosoma sagittifolium)- raw

Green beans- canned Leeks - Leeks-raw

Drumstick leaves-raw

Lettuce – medium handful raw

Cho-cho/christophene - cocoyam leaf Jute leaves-raw

Mixed vegetable - frozen

ColeslawDrumstick leaves Pak choi

Mushrooms - canned Courgette - Jute leaves Okra -fried

Okra-cannedCurly kale

Taro leaves-rawOnion raw or cooked

Green/French beansMushrooms -raw/fried

Vernonia leaves bitter leaf-raw

Peas- canned Peas- Butternut squash-roasted

Mangetout- raw/fried 2 tblsp

Mixed vegetables canned

Tomato puree

Spring onion 3 raw

Pumpkin Pepper ½ - rawOkra -

Runner beans Sorrell= 2tblspSweetcorn - weighed on the cob Spring greens Pumpkin leaves -Water chestnuts -canned Squash e.g. butternut

Spinach (not the baby type)

Watercress- raw 40g Cocoyam leaf

Sweetcorn –canned,fresh, frozen or baby sweetcorn Tomatoes-raw or tinned.

Vernonia leaves/bitter leaf -boiled

Cabbage 2tblsp rawMangetout peas raw/fried 2tblsp

Many African and Caribbean curries use tomatoes as a base. Canned plum tomatoes that are drained are lower in potassium than fresh tomatoes. It is recommended that you use

1 tblsp= tablespoon

canned whole plum tomatoes and drain off the juice before adding to curries, and avoid tomato puree.

Beans and pulses- see protein section.

Fruit

A portion is 80g unless stated otherwise in the table below. If one portion of fruit is not taken, you can swap for a portion of vegetables or a handful of salad. Canned fruit should be drained before eating. As a general rule, dried fruit, fruit or vegetable juices or smoothies should be avoided as they are concentrated sources of potassium

LOW MEDIUM HIGH

Apples, 1 small Apples, baked 1 medium Apricots 2

Blueberries, 40 Apricots (canned) 3 halves Banana 1 small

Cherries (canned) 1/3 of 425g large can tin Blackberries16 coconut, dessicated, 1 tbsp

Clementine , 2 small/1 medium Blackberries (stewed) 2 tbsp Damsons, 3 fruit

Fig, 1 fruitBlackcurrants (canned), 2-3 tbsp Jackfruit

Mamee Apple- 1 fruit Cherries, 20 Nectarine 1 mediumFruit cocktail (canned) 1/3 of 415g can small tin Grapefruit, 1/2 fruit Orange 1 mediumGooseberries (canned) ½ of300g tin3 tbsp Grapes, 16 Ortaniques, 1 Gooseberries (stewed) 2 tbsp Greengages, 1 fruit Plum 2 small Grapefruit (canned) 1/4 tin Guava, 1 small Pomegranate, 1/2Guava, (canned) 1/3 of 410g can 2 tin Kiwi fruit, 1 medium Prickly pears, 1 medium Lemon/lime Kumquats, 10 Quince, 1/2 fruitLime Loquats, 6 Sharon fruit/persimmon, 1

Lychees (canned) 6 fruit Lychees, 5Sugar apple (custard apple) 1/2 medium

Mandarin oranges (canned) 1/2 small 298g can Mango, 2 slices Tamarillos, 1 fruitOlives, green, in brine, drained, 20 Medlars, 1 SoursopOranges, 1/2 medium Melon, 1/2 slice

Passion fruit, 2 fruit Mulberries (stewed), 2 tbsp

Peach, 1 small Papaya, 1/2 slicePeach (canned)1/3 of 420g can 2 halves Pear, 1 smallPear (stewed/canned), 2 halves Physalis, 10 fruitPear (canned) 2 halves Pineapple, 1 slicePineapple (canned) 2 rings/12 chunks

Plums (stewed), 3 halves

Plums (canned) 4 halves Raspberries, 16

Pomelo, 1/4 fruitRaspberries (stewed), 2 tbsp

Rambutan 8 Sapodilla, 1 fruit Very High (avoid)Raspberries (canned) 1/2 300g can can Strawberries, 7-9 fruitRhubarb (canned) 1/3 of 539g tin  Tamarind (sweet) 5 Avocado, Satsuma 1, 2 small Blackcurrants (stewed)Strawberries (canned) 1/2 tin Baobab Tangerine, 1 medium   Dates ( Watermelon, 1/2 slice   coconut   Goji berries     Grenadillas/granaditta    (dried)  Prunes (canned/stewed) =

Redcurrants   Rhubarb (stewed)   Whitecurrants

Tamarind paste (put in misc)

Starfruit/carambola can be toxic for patients with kidney disease, please avoid. Grapefruit can interfere with some medications, please check with your doctor.

Protein

Protein is necessary for growth and repair and the building and maintaining of muscle. Your dietitian will suggest the amount of protein you requiredaily . General advice on protein foods include:

Choose either lean meat chicken, fish,eggs,beans or lentils.

Cured and salted meats, chicken, fish are high in salt. These foods must be kept to a minimum.

A portion of beans, pulses, dhal, Quorn or soya products can replace a portion of meat/fish/chicken/eggs. Canned and drained versions of pulses and beans tend to be lower in potassium than dried versions.

Beans and peas such as kidney beans, gungo peas and foods that contain beans

such as akari, rice and peas, waakye and moin-moin can be high in potassium. Please discuss these with your dietitian as this will depend on what your potassium levels were like when you had them in the diet and also your current kidney function.

Nuts and seeds (groundnut, egusi, jansang, okuahene, wama) are high in

potassium and may need to be restricted. If you need to use small amounts in cooking, please discuss with your dietitian.

Soups

Soups made with nuts or seeds such as groundnut soup, palm nut soup and egusi soup can be high in potassium, a light soup may be a lower potassium alternative. If your potassium is high and you are having soups with nuts or seeds, please discuss with your dietitian.

Dairy Products and milk alternatives

Milk and dairy products play an important role within our diet as they contain protein and essential nutrients such as calcium, which is needed for healthy bones.Dairy alternatives such as plant and grain based milks are a lower source of protein .

Milk is quite high in potassium therefore milk should be limited.A recommended allowance of 300m (1/2pintl milk can be taken daily. This includes cow’s, sheep’s, goat’s milk.

Milk in cereals, milky puddings, yoghurts and milk-based sauces should be counted within this allowance. .

Rice and oat milk are very low in Milk made from nuts containing less than 10% nutfor example almond milk is low in potassium.

Unsweetened soya milk contains approximately half the amount of potassium compared to dairy milk.

Milkshakes, dried milk powder, evaporated milk, condensed milk, coconut milk and creamed coconut are all high in potassium and therefore should be restricted.

All types of cream and cheese may be eaten as usual on a low potassium diet.

Snacks

 Some snacks can be high in energy (calories), salt,sugar and fat such as confectionary, cakes and crisps. Therefore should make up only a small part of your overall diet. However , if you have a poor appetite or are losing body weight, high calorie snacks can be helpful in maintaining or improving your weight. Your dietitian will be able to guide you in making the best snack choices.. .

Savoury snacks

Potato and vegetable crisps are naturally high in potassium and should be avoided.

Crisps or snacks made with lentil/soya/quinoa flour are also high in potassium

Some potato and non-potato crisp varieties have potassium chloride added as a salt substitute. If potassium chloride appears on the ingredients list please avoid.

Low High2 cream crackers Cheese flavoured crackers KelewelePopcorn Kuli Kuli

Pretzels Nuts/Seeds (if you are adding to soups/stews e.g. egusi, ogbono- please discuss with your dietitian)

Tortilla chips 1 small packet Potato/cassava/plantain crisps/Bombay mix

Add medium column, <2mmols, 2-4mmols, >4mmols

Sweet snacks

Healthy eating advice includes reducing your sugar consumption and choosing low sugar or sugar-free varieties. Snacks containing chocolate, nuts, coconut or dried fruit would have a higher potassium content.

If you have diabetes, it is recommended you limit your intake of sugary foods.

Low Potassium <2mmol High potassiumBiscuit – Banana breadBiscuits – Digestives, Rich tea, Shortbread 2

Biscuits containing nuts, chocolate, coconut

Bulla 1 slice Chocolate, dried fruitCakes and Deserts e.g, 1 slice or 1 doughnut

Flapjack

Chinchin Fruit gumsCream filled biscuit 2 Liquorice Allsorts

Rich fruit cakeGingernut 1 Scone containing

dried fruitJam filled biscuits 2 Shuku ShukuJelly Peanut or nut brittlesMarieMeringueMints, sherbert,

Plain sconePopcorn- 28g or ½ bowlRich TeaRing doughnutSandwich biscuitshortbreadSponge cake – plain, cream, jam 1 sliceSweets- boiled, chewy, pastilles, jelly, marshmallows 10Swiss roll- 1 sliceTurkish DelightWafer

DrinksIf you are following a fluid restriction, ensure you count your entire fluid intake as part of your daily allowance. Please consult your doctor if you are unsure of your fluid allowance.

Low <1 High >1

Non-alcoholic drinksBarley water, squash Fruit and vegetable juices/smoothies

Fizzy drinks Drinking chocolate with milk

Coffee, infusion Evaporated milk/condensed milk

Fruit squash Horlicks

Herbal Tea, infusion Juices

Lemonade Milk shake

Lucozade MiloChocolate malted drink e.g Milo

Tonic water Noni juice

Teas Ovaltine with milk

Peanut punch

Tomato juice

Alcoholic drinks

Liqueurs (all) Beer, bitter

Gin Cider, dry & sweet

LiquersSpirits Lager

Shandy Lager, alcohol free

Sherry, small glass Port

Vermouth, dry Red Wwine (all)

Vodka Rose wine

Whisky Stout, Guinness

White wine

Other ingredientsSome common miscellaneous foods are listed here. If you use these foods regularly or use large quantities, please seek advice from your dietitian.

Akaun/akawn (Nigerian Potash) is high in potassium, so avoid using this as a meat or okra tenderiser.

Choose Limit

Herbs e.g coriander, ginger Brown sauceSpices e.g. garlic, chilli Chocolate spreadPickles Nut buttersChutneys Tomato ketchupMayonnaise Tomato pureeMustard Yeast extract e.g Marmite/VegemiteVinegar

Processed foods are high in salt, and should be limited for example. soya sauce, stock cubes and MSG (monosodium glutamate). Salt substitutes e.g. Lo salt, So-Lo, Low sodium salt contain potassium in place of sodium. It is important that all salt substitutes are avoided.

Also avoid salt substitutes e.g. Lo salt, Saxa SoLo as they contain potassium chloride.

If you need further information on a low potassium diet, please contact your dietitian.

Produced by the Renal Nutrition Group of the British Dietetic Association

Acknowledgements:

Deepa Kariyawasam, Renal Specialist Dietitian, King’s College Hospital NHS Trust (Lead contributor)Tadala Kolawole, Renal Specialist Dietitian, Barts NHS TrustLakshmi Chandrasekharan, Diabetes & Renal Specialist Dietitian, Southend University Hospital NHS Foundation Trust Susan Dawe, Renal Specialist Dietitian, Gloucestershire Hospital NHS Foundation TrustTina Dilloway, Renal Specialist Dietitian, Imperial College Healthcare NHS TrustSeverine Gregory-Smith, Renal Specialist Dietitian, Churchill Hospital NHS Trust Ruple Patel, Renal Specialist Dietitian, Epsom and St Helier University Hospital NHS Trust Gabby Ramlan, Diabetes & Renal Specialist Dietitian, North Middlesex University Hospital NHS Trust Patients from King’s College Hospital, Birmingham and other UK renal units.

A Guide to a Low Potassium Diet

Incorporating South Asian Foods

Introduction

The dietary advice in this booklet has been developed by renal dietitians.

What is potassium?Potassium is a mineral that is found naturally in many foods. Some potassium is needed as part of a healthy diet. It is required to ensure healthy working muscles, including the heart.

Your potassium level should be 3.5 – 5.5mmol/l (3.5 – 6.0mmol/l if on haemodialysis)

Why do I need to control the amount of potassium in my blood?Too much potassium in your blood can be dangerous as it affects the rhythm of your heart and can cause your heart to stop beating if levels are very high.

Why is the level of potassium in my blood too high?The level of potassium in your blood is controlled by the kidneys. When your kidneys are not working properly, the potassium level in your blood may rise. It is quite common for people with kidney problems to have too much potassium in their blood.

Can I tell if my potassium is high?There are usually no symptoms to indicate if your potassium is high and the most reliable way to tell is by having a blood test.

What should I do to control my blood potassium levels?You can control your potassium levels by:

Following a low potassium diet Ensuring regular bowel habits as you lose some potassium in the stool If you are diabetic, ensuring good blood sugar control If you are on dialysis, keeping to your scheduled sessions and times

How do I follow a low potassium diet?This booklet provides information on which foods are high in potassium, and those that need to be limited. It offers lower potassium alternatives to keep your blood potassium levels within range. Your dietitian will advise you on the changes that you need to make.

Will the low potassium diet include healthy eating advice?This resource only focuses on a low potassium diet. We have aimed to include low potassium foods that are suitable swaps for foods commonly eaten, e.g. doughnut can replace fruit cake. For this reason, some of the foods in the low potassium section may be high in sugar, salt or fat. Please take into consideration any other diet you may be following when making choices from the suitable/ low potassium columns. If there are any questions, please discuss with your renal dietitian.

Carbohydrate (Starchy foods)________________________________________________________________________

Carbohydrates, also known as starchy foods, provide energy, vitamins and fibre. You should try to include something starchy at each meal to provide you with energy.

Examples of carbohydrates include:

Potato, sweet potato, cassava and yam Rice, pasta and other grains, for example, semolina, bulgar wheat, barley, sago Breakfast cereals, upma, pawa Bread, chapatti, paratha, puri and hoppers

Starchy root vegetables

Some starchy root vegetables like potato, sweet potato, cassava and yam are particularly high in potassium and need to be limited in the diet. Choose only one serving per day, see table below.

Other starchy foods based on wheat or rice can be lower in potassium and are good alternatives. If you do not usually eat high potassium starchy root vegetables, you may be able to have more foods elsewhere in your diet.

Choose only one BOILED 150g serving per day

Limit

Cassava Baked/ fried/roasted/steamed/pressure cooked cassava, taro, green banana, potato, sweet potato, yam

Colacasia/ taro

Green banana Instant mashed potato varieties

Potato Frozen/oven/microwave/retail chips

Sweet potato Manufactured potato products, e.g. hash browns, potato waffles, wedges, croquettes, fritters

Yam

Cooking instructions for starchy root vegetables

The starchy root vegetables in the table above should be boiled in water to lower their potassium content. Discard the water after boiling and do not use for stock, soups, dahls and sauces.

The skins on potatoes provide a good source of fibre and B vitamins. However, if your potassium levels are often high, peel your potatoes and cut into small pieces before boiling, as this helps to remove more.

Baking, frying, roasting and steaming starchy root vegetables do not reduce potassium. Pre-boiling helps to remove some potassium before cooking in this way.

Microwaving is only suitable for reheating starchy root vegetables that have previously been boiled.

Rice, pasta, noodles and other grains

Pasta may be eaten freely in its various forms, for example spaghetti, vermicelli or penne. All varieties of rice are low in potassium, for example flaked/ puffed/ red rice. The more fibre rice or pasta contains (wholemeal products), the higher the potassium content. Some examples of low potassium boiled grains include; barley, bulgar wheat, sago and semolina. Grains such as quinoa, bajra, jowar and ragi have a higher potassium content so use sparingly. Soya flour and soya beans should be avoided due to very high potassium levels.

Breakfast cereals

Cereals made from wheat, oats, rice and corn are lower in potassium and can be eaten regularly.

Cereals containing bran/ dried fruits/nuts/chocolate are higher in potassium and should be limited.

Milk and yoghurt added to cereals should be counted within your dairy allowance (see dairy section).

If you have diabetes, choose lower sugar containing breakfast cereals.

Breads

Bread, rolls, pittas, wraps without nuts and seeds are low in potassium and can be eaten regularly.

Breads containing nuts/ dried fruits/chocolate/coconut are high in potassium and should be limited such as peshwari naan and pittu.

Indian breads such as, chapatti, thepla, puri, idli, dosa and hoppers are low in potassium.

Stuffed vegetable parathas and masala dosas with potato fillings should be limited due to their higher potassium content.

Fruit and Vegetables

_________________________________________________________________________

Fruit and vegetables are a good source of vitamins, minerals and fibre and form a large part of a healthy balanced diet. The potassium content of all fruit and vegetables varies and these are listed in the table below as low, medium, high and very high.

Aim for a total of 4-5 portions of fruit and vegetables daily or as advised by your dietitian. Choose most of your fruit and vegetables from the low or medium columns. If choosing from the high column, you may need to reduce the number of fruit and vegetable portions you have that day. Fruit and vegetables listed as being very high in potassium should be avoided.

All vegetables should be boiled, rather than steamed or microwaved. Boiling allows some of the potassium to leach into the water which should then be thrown away, not used for sauces or gravies.

Canned fruit and vegetables should be drained before eating.

Vegetables and Salad

A portion of vegetables is 80g and boiled unless stated otherwise in the table below. If one portion of vegetables is not taken, then you can swap for a portion of fruit or handful of salad.

Low Medium High Very High

Beetroot (pickled)4 slices

Asparagus 3 spears Beetroot 1 small

Artichoke

Cabbage 2 tbsp

Aubergine (fried/ baked) ¼

Brussel sprouts frozen or fresh

Betal leaves

Cauliflower 3 florets

Broad beans 3 tbsp

Drumstick leaves Butternut squash (roasted)

Cucumber Broccoli 2 medium florets

Green/ French beans 3 heaped tbsp.

Kantola

Fenugreek leaves Cabbage (raw) 2 tbsp Karela Karela (fried)Karela (canned) Carrots

1 mediumLeek (fried) Okra (stir-fried)

Kantola (canned) Celery (raw) 1 stick Mushrooms (fried)1 tbsp

Patra leaves

Lettuce (raw) medium handful

Courgette Okra 9 medium pieces

Spinach, baby variety (boiled/raw)

Marrow Curly kale Parsnip 2 tbsp Tomato pureeMixed vegetables frozen

Gourd – ash, bottle/ dhudi, ridge/ turya

Spinach (not the baby variety)

Okra canned Mange-tout (raw/fried) 2 tbsp

Onion (fried, used as a base in curry)

Peas

Onion (raw) 1 small Pepper (raw) ½Pumpkin Sweetcorn(canned/

fresh/frozen) 3 tbsp

Runner beans Tomatoes (raw) 1 med

Spring onions (raw) 3 Tomatoes (canned) 80g/¼ can

Sugar snap peas 2 tbsp

Turnip

Swede 2 tbspTindora/Ivy gourd (fried)Watercress (raw) 40g

tbsp = tablespoon

Many South Asian curries use tomato as a base. Canned plum tomatoes that are drained are lower in potassium than fresh tomatoes. It is recommended that you use canned whole plum tomatoes and drain off the juice before adding to curries, and avoid tomato puree.

Fruit

A portion is based on 80g unless stated otherwise in the table below. If one portion of fruit is not taken, then you can swap for a portion of vegetables or handful of salad. Canned fruit should be drained before eating.. As a general rule, dried fruit, fruit or vegetable juices and smoothies should be avoided as they are concentrated sources of potassium.

Low Medium High Very High

Apple 1 small Blackberries 16 Apricots 2 AvocadoBlueberries Cherries 20 Custard apple

½ medium Banana

Clementine 1 Grapefruit ½ Jack fruit Coconut Fig 1 Grapes 16 Nectarine 1

mediumDates

Fruit pie filling (various) ¼ of 410g can

Guava1 small Orange 1 medium Prunes canned/stewed

Fruit cocktail1/3 of 415g can

Kiwi 1 Plum 2 small Rhubarb stewed

Lemon/ lime 1 Loquats 6 Pomegranate ½Mandarin oranges½ of 298g can

Lychees 5 Sharon fruit /persimmon 1

Passion fruit 2 Mango 2 slicesPeach 1 small Melon ½ slicePineapple canned2 rings/12 chunks

Papaya ½ slice

Satsuma 1 Pear 1 smallWatermelon ½ slice Pineapple 1 slice

Raspberries16Sapodilla / chikoo 1 Strawberries 7

Starfruit can be toxic for patients with kidney disease, please avoid. Grapefruit can interfere with some medication, please check with your doctor.

Protein

_______________________________________________________________________

Protein is necessary for growth and repair and the building and maintaining of muscle. Your dietitian will suggest the amount of protein you require daily. General advice on protein foods include:

Choose lean meat, chicken, fish or eggs. Cured/smoked, salted, tinned and processed meats and some fish are high in salt.

These foods should be kept to a minimum. A portion of beans, pulses, dhal, paneer, Quorn, tofu or soya products can replace a

portion of meat, chicken, fish or eggs. Canned and drained versions of pulses and beans tend to be lower in potassium than dried versions.

Nuts and seeds are high in potassium and may need to be restricted. If you need to use small amounts in cooking, please discuss with your dietitian.

Lentil flours are a valuable source of protein and can be used as part of composite dishes.

Soups___________________________________________________________________

Packet and tinned soups are not encouraged due to their high salt and potassium content, and they can displace more nutrient-dense foods in the diet. Additionally, if you are on a fluid restriction, they would also count towards your fluid allowance for that day.

Please do not consume herbal/ayurvedic soups or tablets as their side effects are not known in patients with kidney disease..

Dairy Products and alternatives

_________________________________________________________________________

Milk and dairy products play an important role within the diet as they contain protein and essential nutrients such as calcium, which is needed for healthy bones. Dairy alternatives such as plant and grain based milks are a lower source of protein.

Milk is quite high in potassium so should be limited. A recommended allowance of 300ml (1/2 pint) milk can be taken daily; this includes

cow’s, sheep’s and goat’s milk. Milk in cereals, milky puddings, yoghurts, yoghurt drinks, raita, lassi, buttermilk, milk-

based probiotics and milk-based sauces must be counted within this allowance. Rice and oat milk are very low in potassium. Milk made from nuts containing less than 10% nut, for example almond milk is low in

potassium. Unsweetened soya milk contains approximately half the amount of potassium

compared to dairy milk. Milkshakes, dried milk powder, evaporated milk, condensed milk, coconut milk and

creamed coconut are all high in potassium and therefore should be restricted. All types of cream and cheese and paneer can be eaten as usual on a low potassium

diet.

Snacks

_________________________________________________________________________

Some snacks can be high in energy (calories), sugar, fat and salt, such as confectionery, cakes and crisps. Therefore they should make up only a small part of your overall diet. However, if you have a poor appetite or are losing body weight, high calorie snacks can be helpful in maintaining or improving your weight. Your dietitian will be able to guide you in making the best snack choices.

Crisps

Potato and vegetable crisps are naturally high in potassium and should be avoided. Crisps made with lentil /soya/quinoa flour are also high in potassium. Some potato and non potato crisp varieties have potassium chloride added as a

salt substitute. If potassium chloride appears on the ingredients list please avoid.

South Asian Snacks

Some South Asian snacks serve as mini meals and are an important part of the Asian diet and culture. As with all food items, the potassium content varies and so they are listed below as low, medium and high. In accordance with your weight, dietary intake and potassium levels, your dietitian will recommend which snacks are best for you to eat.

Low Medium High 3 Breadsticks 1 chakri Bhajia1 Corn fritter 1 Farsi puri Bombay mix2 Cream crackers 1 Meat / veg samosa Banana /plantain/Cassava

crisps

2 squares Dhokla 1 Papadum/ papad Cassava chips (mogo)3 tbsp Masur Papdi nu lot (rice flour

dumpling)Dal dhokli

4 tbsp Mumra (puffed rice) Fried peas1 Papdi Gathiya/sev½ bowl Pawa (rice flakes) Lentil cutlet½ bowl Popcorn Pakora1 small packet Tortilla chips Patra½ bowl Upma Potato /lentil/ soya/quinoa

crisps4 tbsp Vermicelli (roasted) Nuts

Roasted channaRoasted corn kernalsSoya beansWhole green gram

tbsp = tablespoon.

Sweet Snacks

_________________________________________________________________________

Healthy eating advice includes reducing your sugar consumption, and choosing low sugar or sugar free varieties where possible. South Asian sweets can be high in potassium, so as a general rule, avoid those that contain evaporated or condensed milk, nuts, dried fruit, dried milk powder or coconut milk; and choose or make your own using lower potassium ingredients. If you have diabetes, it is recommended you limit your intake of sugary foods.

Low High Biscuits Biscuits1 Ginger nut Chocolate biscuits2 Plain or semi-sweet biscuits2 Sandwich biscuit- Jam/cream filled Cakes/Desserts Cakes/Desserts1 slice Cake e.g sponge, cream Flapjack1 Doughnut Scone with dried fruitIndividual fruit pie TrifleJelly MeringueSweets Sweets10 Boiled, chewy, fruit pastilles Liquoricejellies, marshmallows, mints, sherbet Nut brittle½ bowl Sweet popcorn Sesame snacksTurkish delightSouth Asian sweets South Asian sweetsAsmi Aggala1 Gulab jamun Barfi2 JalebiJelly halva70g Siro/ karah70g Shandesh70g ZardaMilky puddings (from milk allowance)Custard, ice cream, yoghurt, All chocolateskheer, rasgulla, rasmali, semiya payasam

Drinks_________________________________________________________________________

If you are following a fluid restriction, ensure that you count your entire fluid intake as part of your daily allowance.

Please consult your doctor if you are unsure about your fluid allowance.

Low High Barley water, diluted squash Coffee (instant) Fizzy drinks Drinking chocolate powderFruit squash Fruit and vegetable juices/ smoothiesHerbal Tea Malted drink powder with milk e.g.

Horlicks, Ovaltine, MiloLemonade Milk shake powderLucozadeTonic waterTeas

Alcohol

Low High Liqueurs Beer, BitterShandy CiderSherry LagerSpirits Lager, alcohol freeVermouth Port

Stout, GuinnessWine

Miscellaneous

__________________________________________________________________

Some common miscellaneous foods are listed here. If you use these regularly in cooking, or consume large quantities, please seek advice from your dietitian.

Low High Apple sauce Black treacleGravy granules/ stock cube Brown sauceHerbs, spices Chocolate spreadsHoney/ syrups HorseradishJam/ preserves/ lemon curd Instant soup powdersPickles and chutney Nut buttersMint sauce PestoMustard/ mayonnaise/salad cream Tahini

Sandwich pickle Tamarind pasteStuffing (without dried fruit) Tomato ketchup, pureeVinegar Yeast extracts e.g. Marmite, Vegemite

Herbs, curry spices, coriander, chilli, garlic and ginger can be used as required.

Processed foods are high in salt and should be limited, for example, soya sauce, stock cubes and MSG (Mono Sodium Glutamate).

Salt substitutes e.g. Lo-Salt, So-Lo, Low Sodium Salt contain potassium in place of sodium. It is important that all salt substitutes are avoided.

If you need further information on a low potassium diet, please contact your dietitian.

Produced by the Renal Nutrition Group of the British Dietetic Association

Acknowledgements:

Ruple Patel, Renal Specialist Dietitian, Epsom and St Helier University Hospital NHS Trust (Lead contributor) Lakshmi Chandrasekharan, Diabetes & Renal Specialist Dietitian, Southend University Hospital NHS Foundation Trust (Lead contributor)Tina Dilloway, Renal Specialist Dietitian, Imperial College Healthcare NHS Trust (Lead contributor)Severine Gregory-Smith, Renal Specialist Dietitian, Oxford University Hospitals NHS Foundation Trust Susan Dawe, Renal Specialist Dietitian, Gloucestershire Hospital NHS Foundation Trust Deepa Kariyawasam, Renal Specialist Dietitian, King’s College Hospital NHS Foundation TrustGabby Ramlan, Diabetes & Renal Specialist Dietitian, North Middlesex University Hospital NHS Trust

A Guide to a Low Potassium Diet incorporating Chinese and Far Eastern Foods

Introduction

The dietary advice in this booklet has been developed by renal dietitians.

What is potassium?Potassium is a mineral that is found naturally in many foods. Some potassium is needed as part of a healthy diet. It is required to ensure healthy working muscles, including the heart.

Your potassium level should be 3.5 – 5.5mmol/L (3.5 – 6.0mmol/L if on haemodialysis)

Why do I need to control the amount of potassium in my blood?Too much potassium in your blood can be dangerous as it affects the rhythm of your heart and can cause your heart to stop beating if levels are very high.

Why is the level of potassium in my blood too high?The level of potassium in your blood is controlled by the kidneys. When your kidneys are not working properly, the potassium level in your blood may rise. It is quite common for people with kidney problems to have too much potassium in the blood.

Can I tell if my potassium is high?There are usually no symptoms to indicate if your potassium is high and the most reliable way to tell is by having a blood test.

What should I do to control my blood potassium levels?You can control your potassium levels by:

Following a low potassium diet Ensuring regular bowel habits as you lose some potassium in the stool If you are diabetic, ensuring good blood sugar control If you are on dialysis, keeping to your scheduled sessions and times

How do I follow a low potassium diet?This booklet provides information on which foods are high in potassium, and those that need to be limited. It offers lower potassium alternatives to keep your blood potassium level within range. Your dietitian will advice you on the changes you need to make.

Will low potassium diet include the healthy eating advice?Healthy eating for patients with kidney disease should include choosing reduce salt and sugar containing choices.

This resource only focuses on a low potassium diet. We have aimed to include low potassium foods that are suitable swaps for foods commonly eaten, e.g. doughnut can replace fruitcake. For this reason, some of the foods in the low potassium section may be high in sugar, salt or fat. Please take into consideration any other diet you may be following when making choices from the suitable/low potassium columns. If there are any questions, please discuss with your renal dietitian.

Carbohydrate

Carbohydrates, also known as starchy foods, provide energy, vitamins and fibre. You should try to include something starchy at each meal to provide you with energy.

Examples of carbohydrates: Potato, sweet potato, cassava and yam Rice, noodles, pasta and other grains Breakfast cereals Breads, bao

Starchy Root Vegetables

Some starchy root vegetables like potato, sweet potato, cassava and yam are particularly high in potassium and need to be limited in the diet. Choose only one serving per day, see table below. Other starchy foods based on wheat or rice are low in potassium and are good alternatives. If you do not usually eat high potassium starchy root vegetables, you may be able to have more potassium foods elsewhere in your diet.

Choose only one boiled 150g serving per day

Limit

CassavaPotatoesRadish WhiteRadish RedSweet potatoTaroYam

Baked/ fried/ roasted/ steamed/ pressure cooked taro, potato and sweet potato

Frozen/oven/microwave/retail chips

Instant mashed potato varieties

Manufactured potato products # : hash browns, potato waffles, potato wedges, potato croquettes, potato fritters

Steamed starchy vegetables

# High salt foods

Cooking Instructions for starchy root vegetables

The starchy root vegetables in the table above should to be boiled in water to lower their potassium content. Discard the water after boiling and do not use for stock, soups and sauces.

The skins on potatoes provide a good source of fibre and B vitamins. However, if your potassium levels are often high, peel your potatoes and cut into small pieces before boiling, this helps to remove more potassium.

Baking, frying, roasting and steaming starchy root vegetables and grains does not reduce potassium. Pre-boiling helps to remove some potassium before cooking in this way.

Microwaving is only suitable for reheating starchy root vegetables that have previously been boiled.

Rice, noodles, pasta and other grains

Noodles, rice, glutanous rice, sago, pasta and some other boiled grains such as pearl barley are low in potassium and can be eaten freely.

Breakfast cereals

Cereals made from wheat, oats, rice and corn are lower in potassium and may be eaten

regularly.

Cereals containing bran, dried fruits, nuts and chocolate are higher in potassium and

should be limited.

Milk and yoghurt added to cereals should be counted within your dairy allowance (see

dairy section).

If you have diabetes, choose lower sugar containing breakfast cereals.

Breads

Bread, rolls, pittas and crackers without nuts and seeds may be eaten regularly.

Breads and crackers containing nuts, seeds, coconut, dried fruits and chocolate are

higher in potassium and should be limited.

Fruit and Vegetables

Fruit and vegetables are a good source of vitamins, minerals and fibre and form a large part of a healthy balanced diet. The potassium content of all fruits and vegetables varies and these are listed in the table below as low, medium, high and very high.

Aim for a total number of 4-5 portions of fruits and vegetables daily or as advised by your dietitian.

Choose most of your fruits and vegetables from the low or medium columns. If choosing from the high column, you may need to reduce the number of fruit and vegetable portions you have that day.

Fruit and vegetables listed as being very high in potassium content should be avoided.

All vegetables should be boiled, rather than steamed or microwaved. Boiling allows some of the potassium to leach into the water which should be thrown away and not used for gravy or stock.

Canned fruit & vegetables should be drained before cooking or eating

Vegetables and salads

A portion of vegetables is 80g and boiled unless otherwise stated in the table below. If one portion of vegetables is not taken, then you can swap for a portion of fruit or a handful of salad.

LOW MEDIUM HIGH VERY HIGH Beansprout or Taugeh 3 Tbsp

Aubergine (fried/baked) 1/4

Asparagus (fried) 3 spears Avocado

Beetroot (pickled/drained) 4 slices

Bamboo shoots (canned) 1/4 small tin Brussel sprouts Butternut squash

Butternut squash 2 tbsp Broad beans 3 tbsp Courgette (raw) 1 small Celeriac (raw) Cabbage 2 tbsp Butternut Squash Curly kale, raw Chard (boiled) Carrots (canned/drained) 4 small Broccoli 2 med florets Fennel (raw) 2 tbsp Choi sum (raw)

Cauliflower 3 florets Cabbage (raw) 2 tbsp Green beans 3 tbspEdamame beans (frozen/prepared),

Cucumber Carrots1 medium Kerala Lohbak, Chinese radish

Gherkins 2 medCelery (raw) medium 1 stick Leeks (raw) 1/2 stalk Mushroom (dried)

Green/french beans (canned) 3 tbsp Courgette

Mushrooms (raw/fried) 6 medium Okra stir fried

Lettuce (raw) medium handful Curly kale Okra 10 fingers KantolaMange tout 2 tbsp Leeks 1/2 stalk Parsnip 2 tbsp Karela fried Marrow Mange-tout (raw) 2 tbsp Spinach (not baby) Kailan (raw) Mixed vegetables (frozen) Peas 2 tbsp

Pak choi (raw) Plantain (fried) 1/2

Mushroom (canned)Pepper red/yellow/green (raw) 1/2 Spinach, baby (raw)

Olives, green, in brine, drained, 20 Spring greens 2tbsp Tomato puree

Onions (raw), 1 small

Sweetcorn, (canned/fresh/frozen) 3 tbsp  

Pumpkin 2 tbsp Tomatoes (canned/raw)Radish (raw) Turnip

Rocket (raw) medium handful Water chestnuts (raw) 5Runner beansShallots (raw)Spring onions (raw) 3Sugar-snap peas 2 tbspTung Kuah /Water gourd/ winter melon Tung Choi/Morning GloryWatercress, raw 40gWater chestnuts (canned)

tbsp = tablespoon

If you are using tomatoes in cooking, choose canned plum tomatoes that are drained are lower in potassium than fresh tomatoes. It is recommended that you use canned whole plum tomatoes and drain off the juice before adding to your cooking, and avoid tomato puree.

Fruits

A portion is based on 80g unless stated otherwise in the table below. If one portion of fruit is not taken, then you can swap for a portion of vegetables or a handful of salad. Canned fruit should be drained before eating. As a general rule, dried fruit, fruit or vegetable juices and smoothies should be avoided as they are concentrated sources of potassium.

LOW MEDIUM HIGH VERY HIGHApple 1 small Blackberries 16 Apricots 2 CoconutBlueberries Cherries 20 Banana 1 small CurrantsChinese pear (yellow) 1 medium Ciku, Sapodilla 1 fruit Custard apple ½ medium DatesClementine 1 Grapefruit 1/2 Jackfruit, cempedak Goji berriesDuku Grapes 16 Jackfruit, nangka Grenadilla / Delima Durian Guava 1 small Nectarine 1 medium Tamarind pasteFig 1 Hog plum, kedongdong Orange 1 mediumFruit cocktail 1/3 of 415g can Kiwi 1

Persimmon/ Sharon fruit 1

Lemon/ Lime1 fruit Langsat 5 Plum 2 small Longans (canned) 6 fruits Lychees 5 Pomegranate 1/2

Lychees (canned) 6 fruits Mango 2 slicesPrickly pear/ dragon fruit 1 medium fruit

Mandarin oranges 1/2 of 298g can Melon 1/2 slice SoursopMangosteen, manggis Papaya, 1/2 slicePassion fruit 2 fruits Pear 1 smallPeach 1 small Pineapple, 1 slicePeach (canned) 1/3 of 420g can Raspberries 16 Pear (canned/ stewed) 2 halves Strawberries 7 Pineapple (canned) 2 rings/12 chunks Tamarind (sweet) Plums (canned) 4 halves   Pamelo 1/4 fruit  Rambutan   Satsuma 1    

Tangerine 1    Watermelon 1/2 slice    

 

Starfruit or carambola can be toxic for patients with kidney disease, please avoid.

Grapefruit can interfere with some medications, please check with your doctor or

pharmacist.

Protein

Protein is necessary for growth and repair and the building and maintaining of muscle. Your dietitian will suggest the amount of protein require daily.

General advice on protein foods include:

Choose lean meat, chicken, fish or eggs. Cured and salted meats, chicken and fish are high in salt. These foods must be kept

to a minimum. A portion of beans, pulses, lentils such as baked beans, soy sources such as tofu

and tempeh can replace a portion of meat, chicken, fish or eggs. Canned and drained of pulses, beans and lentils tend to be lower in potassium than

dried and boiled versions. Nuts and seeds are high in potassium and may need to be restricted. If you need to

use a small amount in cooking, please discuss with your dietitian.

Soups

Soups are a regular dish in Chinese diets. They are not generally encouraged in many renal patients due to their high salt and potassium content, and their inclusion can displace more nutrient-dense foods in the diet. Additionally, if you are on a fluid restriction, they would also count towards your fluid restriction for that day.

However, if your potassium levels are well controlled and fluid is not a concern, they can be included in your diet with thoughtful planning. As packet and tinned soups are high in salt and potassium content, you are encouraged to make your own. This way, you can control the amount of salt used and also choose lower potassium ingredients and cooking methods to reduce the amount of potassium in the soup.

Make a meat or chicken stock or use a ready-made low salt stock e.g. Kallo, orBoots baby stock cubes instead of LoSalt. You can use rice, barley or mini pasta shapes to give it body and cornflour can be used to thicken. Choose lower potassium vegetables (see page ***), blanch them and drain before adding to the stock. Flavour your soup with herbs and spices rather than salt.

In addition to the soups made from meat and vegetables served at mealtimes, the Chinese diet can also include traditional herbal medicinal soups. These soups are made from a combination of numerous dried plants, roots, vegetables and herbs, simmered over long periods of time. Due to the nature of the raw ingredients and the cooking method, they can be very high in potassium content. Additionally, there are concerns regarding the safety of their use in chronic kidney disease and any possible interactions with your current medications. Therefore, the use of medicinal soups and alternative or Ayuverdic medicine are not recommended.

Dairy Products and Alternatives

Milk and dairy products play an important role within our diet as they contain protein and essential nutrients such as calcium, which is needed for healthy bones. Dairy alternatives such as plant and grained based milk are lower source of protein.

Milk is quite in potassium therefore milk should be limited.

A recommended allowance of 300ml (½ pint) milk can be taken daily: this includes cow’s, sheep’s and goat’s milk. 

Milk used in cereals, milky puddings, yoghurts, yoghurt drinks, kefir, buttermilk, milk-based probiotics and milk-based sauces should be counted within this allowance. 

Rice and oat milk are very low in potassium.

Milk made from nuts containing less than 10% nut, for example almond milk is low in potassium.

Unsweetened soy milk contains aaproximately half the amount of potassium compared to dairy milk.

Milkshakes, dried milk powder, evaporated milk, condensed milk, coconut milk and creamed coconut are all high in potassium and therefore should be restricted.

All types of cream and cheese may be eaten as usual on a low potassium diet.

Snacks

Some snacks can be high in energy (calories), sugar, fat and salt such as confectionary, cakes and crisps. Therefore, they should make up only a small part of your overall diet.

However, if you have a poor appetite or are losing body weight, high calorie snacks can be helpful in maintaining or improving your weight. Your dietitian will be able to guide you in making the best snack choices.

Crisps

Potato and vegetables crisps are naturally high in potassium and should be avoided. Crisps or snacks made with lentil/soy/quinoa flour are also high in potassium. Some potato and non potato varieties have potassium chloride added as a salt substitute.

If potassium chloride appreas on the ingredients list, please avoid.

Low Medium High

3 breadsticks 33 g cheese flavoured snacks Banana crisps 2 cream crackers 27g corn snacks Brown soy beanPrawn/Fish crackers Cassava crisps24g pork scratching Fried peas ½ bowl salted popcorn unless plain

1 packet potato crisps

1 small packet tortilla chips 30g nuts or seeds

Sweets snacks

Healthy eating advice includes reducing your sugar consumption, and choosing low sugar or sugar free varieties where possible. Snacks containing nuts, chocolates, evaporated or condensed milk, dried fruit, dried milk powder, coconut, coconut milk and gram flour are high in potassium and should be lmited. If you have diabetes, it is recommended that you limit your intake of sugar.

In accordance with your dietary intake, your dietitian will guide you as to which snacks that are safe for you to consume.

Biscuits

Low Potassium Content High Potassium Content2 Plain biscuits e.g. Digestive, Rich Tea, Gingernut, Marie

Biscuits containing nuts, chocolates, dried fruits

2 wafers1 Shortbread 2 Cream or jam filled sandwich biscuits

Cakes and desserts

Low Potassium Content High Potassium Content1 slice Sponge cake (plain, cream ) Cakes or scones containing dried fruit1 Doughnut Banana bread1 Plain scone Trifle

1 slice Swiss roll Chinese sweet peanut soupJelly Dessert or sweet served with coconut milk

e.g. sago pudding Dau fu far (sweet soy curd dessert)

Milky puddings (part of milk allowance)

Low Potassium Content High Potassium Content

Custard Ice cream Yoghurt

SweetsLow Potassium Content High Potassium Content10 Boiled or chewy sweets, fruit pastilles, jellies, marshmallows, mints, sherbets

Fruit gums

½ bowl Sweetened popcorn Liquorice Allsorts Peanut & nut brittles

Drinks

If you are following a fluid restriction, ensure that you count all your fluid intake as part of your daily allowance. Please consult your doctor if you are unsure about your daily amount of fluid allowance.

Low potassium content High potassium contentBarley water, diluted squash Drinking chocolate powder Fizzy drink Fruit and vegetable juices & smoothiesCoffee Malted drink powder with milk e.g.

Horlicks, Ovaltine, Milo Fruit squash Milk shake powder Herbal Tea, infusionLemonadeLucozade Tonic waterTeasSoy drink

Alcohol containing drinksLow potassium content High potassium contentLiqueurs Beer, bitterShandy Cider, dry & sweetSherry LagerSpirits Lager, alcohol freeVermouth, dry Port

Stout, GuinnessWine

Miscellaneous

Some common miscellaneous foods are listed here. If you use this regularly in cooking or consume it in large quantities, please seek advice from your dietitian.

Low HighApple sauce Black treacle Gravy granules/stock cube Brown sauceHerbs, spices Chocolate spreads Honey syrups Instant soup powders Jam/ preserves/ lemon curd Nut buttersMustard/mayonnaise/salad cream Tomato ketchup, puree, chutneyPickles & chutney Yeast extracts e.g. Marmite, Vegemite Vinegar

Processed foods are high in salt and should be limited, for example, soya sauce, stock cubes and MSG (Monosodium Glutamate).

Salt substitutes e.g. Lo-Salt, So-Lo, Low Sodium Salt contains potassium in place of sodium should be avoided.

Herbs, curry spices, coriander, chilli, garlic and ginger can be used as required.

Acknowledgements:Gabby Ramlan, Diabetes & Renal Specialist Dietitian, North Middlesex University Hospital NHS Trust (Lead Contributor)

Severine Gregory-Smith, Renal Specialist Dietitian, Oxford University Hospitals NHS Foundation Trust (Lead Contributor)Deepa Kariyawasam, Renal Specialist Dietitian, King’s College Hospital NHS FoundationTrustLakshmi Chandrasekharan, Diabetes & Renal Specialist Dietitian, Southend University Hospital NHS Foundation Trust Ruple Patel, Renal Specialist Dietitian, Epsom and St Helier University Hospital NHS Trust Susan Dawe, Renal Specialist Dietitian, Gloucestershire Hospitals NHS Foundation Trust Tina Dilloway, Renal Specialist Dietitian, Imperial College Healthcare NHS Trust

Produced by the Renal Nutrition Group of the British Dietetic Association

Dietitian:Contact Details: