Published on February 7th, 2020 | by Michaelw0
How to manage Potassium, Phosphorus and Sodium in Kidney Disease
Hello, this is Katherine, welcome to 00kidney.
In this video, some easy and effective kidney health tips to repair your kidneys.
These tips will be mostly useful for people in stage 3, 4 and 5 of chronic kidney disease.
Because, if you have kidney disease, getting the right amount of potassium, phosphorus and sodium in your diet is really important to improve the health of your kidneys.
There’s no way to repair your kidneys if you are not able to manage these three electrolytes in your renal diet.
So, today I’ll show you what foods to eat and what to avoid do exactly that:
manage potassium, phosphorus, sodium and start to get your kidney function back.
Because you shouldn’t need a degree in chemistry to know what to eat every day.
What we will see is that a lot of kidney patients can still eat bananas and mangos and other potassium rich fruits without problems.
Also, I’ll show you a very little known trick to lower your potassium levels quickly and avoid the dangers of hyperkalemia. There’s a home remedy that does exactly that.
So today I’m gonna answer these questions
How much potassium should you have if you have kidney disease?
What foods should you avoid and what should you eat?
How much phosphorus does a kidney patient need daily?
So let’s start with potassium.
This electrolyte is the bane of many kidney disease patients, but if you learn how to manage it, you can even use it at your advantage to repair your kidneys.
Let’s start from the foods you can eat and the foods you cannot eat, if you have to limit potassium.
In this first slide we can see some foods too rich in potassium.
Here we can see fruits such as bananas, cantaloupe, mango, papaya… but also vegetables like artichokes, potatoes and tomatoes.
Also, some processed products such as salsa, tomato sauce and salt substitutes are included.
These are some of the most common foods kidney patients should avoid when they need to limit potassium, right?
In this second slide,
We can see some low potassium alternatives you can always eat
Some healthy fruits, like apples, berries pineapple
some veggies like corn, eggplant, cucumber
And there is even almond milk, a healthy alternative to cow milk, white rice and popcorn.
All these foods are safe when it comes to potassium, but you also need to consider other factors when adding new things to your diet, like phosphorus and sodium, that we will see in a moment.
So don’t assume you can eat it just because it is in this slide, ok?
And always remember to talk to your doctor before starting to eat anything new, even foods, because there could be interactions with drugs and other unforeseen problems that you may want to avoid.
However, I’ve posted a link to download these two slides in description, if you want to print them.
Knowing what foods are too rich in potassium can help in a lot of cases.
Now, there are basically two problems with potassium. The most common is having high levels of it, which leads to irregular heartbeats, possible heart attack and possible kidney damage. That’s hyperkalemia.
The less common, hypokalemia, is the lack of this essential electrolyte, and even if it less common in kidney patients, it can happen.
This varies greatly with the stage of kidney disease you’re in.
So, let’s try to understand a little bit better who should avoid the high potassium foods of the previous slide and who can still eat them.
This depends on your stage of kidney disease and your kidney function.
Because, if you’re in stage 3 for example, chances are that you can still eat a lot of delicious and healthy high potassium fruits and vegetables like potatoes, tomatoes, bananas and mangos.
So, to answer the question how much potassium should you have if you have kidney disease?
Let’s take a look at this slide.
The number you see here are the stage of chronic kidney disease you’re in, on the left, and the quantity of potassium you can eat in a day on the right.
As we can see from my slide, if you’re in stage 3a, meaning that your GFR is still above 45, chances are that potassium is still not a problem for you.
This is true unless you’re taking prescription drugs that will artificially raise your blood potassium levels. More about this in a moment.
As we can see here, potassium daily allowance in stage 3a can be as high a 4.000 mg. This is a lot more potassium than people usually eat, I mean people without kidney disease.
Potassium restrictions are more common with patients in stage 3b.
In stage 4 and 5, usually you will have to limit potassium to about 2.500 or 2.700 mg a day, as we can see here.
Now, if we think that, for example a medium banana contains more than 400 mg of potassium, we can understand how hard is staying below 2.500 mg of potassium a day.
Because even the foods on the low potassium list have some potassium. One medium apple has about 200mg of potassium for example.
I mean, you have to eat something, right?
But don’t get discouraged, with the right portion control and the right choice of foods managing potassium levels is always possible.
BUT, as I was saying before, you should always keep your potassium levels under control.
And for under control I mean that you should get checked regularly for potassium levels, if you have kidney disease.
And, while for the advanced stages eating a low potassium diet is recommended, if you’re in stage 3 you shouldn’t worry about it unless you’re advised by your doctor otherwise.
I mean, some kidney patients even have too low levels and should eat more potassium rich foods.
As we have seen, the recommended amount of potassium a CKD patient in stage 3 should get is as much as healthy people should get. And not everyone eats enough potassium on a daily basis.
So, there’s only one way to know if your potassium is too high or too low.
Get prescribed a basic metabolic panel\ let your doctor know if your potassium level, or serum potassium, is too high.
The normal range is 3.5 to 5.0 mEq/L.
Now, as I was saying there are medications that cause high potassium levels.
Medications that have been linked to hyperkalemia include
Blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors
Blood pressure drugs called angiotensin-receptor blockers (ARBs), although they are less likely than ACE inhibitors to increase potassium levels
Blood pressure drugs called beta-blockers
Potassium-sparing diuretics, including triamterene, amiloride (Midamor), and spironolactone (Aldactone)
So if you take these medications and your potassium is always high, despite all your efforts to keep it low, maybe you should talk to your doctor and see if there’s a way to lower the dosages.
For some patients, doing changes in their diet, lowering sodium for example can be enough to get a lower dose of beta-blockers.
Obviously this is not something you can do by yourself, you would need your doctor to follow you in this process.
But this is exactly the kind of improvement you would need to do to get your kidney function back: improve your diet and find a way to lower your medications.
So keep on watching this video for more info about lowering sodium in the diet.
As I was saying before there’s a home remedy you can use to lower potassium levels fast.
Not many studies where done on it, so listen to this with a grain of salt.
In some kidney disease patients, sodium bicarbonate, or baking soda, was successfully used to lower serum potassium, or potassium level.
This remedy works when there’s a condition called metabolic acidosis, very common in kidney disease patients.
So, when hyperkalemia results from too much acidity in the blood, baking soda can be prescribed.
Now, while baking soda is pretty safe, and acidosis is common, consult your doctor before taking anything you’re not already taking.
Now, potassium is not the only thing you should keep under control if you have kidney disease.
Phosphorus is maybe even more important to consider when planning your diet.
As you can see from my slide here, phosphorus is even more restricted than sodium for people with kidney disease.
Phosphorus is restricted even for patients in stage 3 of CKD.
Usually, the daily allowance is about 800mg for patients in stage 3, 4 or 5.
So while potassium is usually only restricted for patients in the 4th and 5th stages of kidney disease, phosphorus can be an issue even for patients in the stage 3.
And this includes a lot more people.
Now, the big problem here is that 800mg aren’t really a lot.
Because, for example, just a glass of milk has more than 200mg of phosphorus.
So you will have to be even more careful with phosphorus than you are with potassium.
Phosphorus is the main reason why dairy products are not recommended for people with kidney disease.
Actually, dairy products could cause you bone problems.
Yes, milk is supposed to strengthen your bones, but if you have kidney disease you could obtain the exact opposite effect.
Why? Due to inability of the kidneys to get rid of excess phosphorus.
Your body needs some phosphorus to strengthen your bones and teeth, produce energy, and build cell membranes.
Yet in larger-than-normal amounts, this mineral can cause bone and muscle problems and increase your risk for heart attacks and strokes.
What happens when the kidneys cannot remove it properly?
If there’s too much phosphorus in your diet, your body will remove it binding it with calcium from your bones.
Extra phosphorus causes body changes that pull calcium out of your bones, making them weak.
And this is why people with kidney disease should always watch their consumption not just of dairy but also of the other foods we can see from this slide, like
Beans, nuts, various whole grains, milk and dairy, colas and other packaged foods.
Now, kidney patients are usually more concerned with potassium than phosphorus, because an excess of potassium can kill you. But phosphorus is also very important to keep under control, if you are serious about improving the health of your kidneys.
So what are the correct phosphorus levels?
According to the National Kidney Foundation, CKD patients stages 3 and 4 should keep their phosphorus between 2.7 and 4.6 mg/dL.
Patients on dialysis should keep their phosphorus levels in the 3.0 to 5.5 mg/dL range.
There are usually two ways to do so.
The first is to reduce your phosphorus intake in your diet.
Or, if this isn’t enough, your doctor can prescribe you medications to lower the amount of phosphate your intestines absorb. These medications are called phosphate binder.
So, to recap, kidney patients need lower amounts of phosphorus in the diet to avoid problems with their bones.
Most of these foods are also too rich in sodium, another thing people with kidney disease should keep under control.
Now, this is maybe the most important thing to control in your diet, if you’re serious about repairing your kidneys.
Sodium. Or salt.
Because a lot of people eat way too much of it. Ok, basically everyone eat too much of it, at least according to the CDC, center for disease control and prevention.
The recommended sodium intake is less than 2300mg per day, for healthy people, while the average American consumes more than 3,400 mg of sodium per day.
Yes, people tend to eat more salty foods because… they’re tastier, what a discovery!
Now, for people with kidney disease, diabetes or hypertension, usually the recommended daily amount of sodium is even lower, at 1500 mg a day as you can see here.
This is because excess of sodium can cause a lot of problems with our kidneys, hypertension being just one of these.
And, according to the CDC, most of the sodium people consume is not coming from the salt shaker.
So, let’s see from what foods people are getting all this sodium.
As we can see from my slides, some of the foods you should avoid to get less sodium include
fast foods, processed meats, bacon, shortenings, but also salad dressings, some canned foods, pickles, processed cheeses and snacks.
This is a fairly comprehensive list of … junk foods that people should be just avoiding.
I am not here to demonize salt or sodium in general. In fact, sodium is essential to our bodies functioning properly, and it’s one of the nutrients we need so we don’t end up with an electrolyte imbalance. The problem is that many people are consuming way too much sodium on a daily basis, filling up on unhealthy sodium-rich foods, which is why a low-sodium diet is the way to repair your kidneys.
To do so, you should consume no more than 1500 mg of sodium each day. That’s one teaspoon. Just one.
Eating too much salt can make it harder for your kidneys to remove fluid, which builds up in your system and increases your blood pressure.
So people with kidney disease are often recommended to avoid table salt.
So, looking at my slide here, avoiding packaged foods may be a good strategy to avoid sodium right?
And, if you can’t do that, always check the labels of what you’re buying.
Checking labels is the only way to know how much sodium there is in your food. If you buy packaged or processed foods, choose foods that are labeled “sodium-free” or “very low sodium.”
Now, a very important thing.
You cannot do everything by yourself. If a lot of people here on 00kidney are dramatically improving their kidney function, it’s because they got the help they need.
And, one thing that’s helping a lot of people is this program.
This is a comprehensive guide to the diet, supplementation and medications created to help people in stage 3, 4 and even 5 of kidney disease to get their kidney function back.
And it works.
Click here for more info.
This is all for today, thank you for watching.