How potassium affects kidney patients
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Introduction
Welcome to Hot Topics and Kidney Health, brought to you by the National Kidney Foundation. Each episode we highlight the latest in kidney research. Bring you up to date news in kidney care, dispel myths and answer your kidney health questions. One of the jobs of your kidneys is to manage your body's levels of potassium, which keeps your heartbeat regular and your muscles working right.
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Introduction
Many kidney patients need to watch what they eat to ensure that their potassium levels don't become too high and cause dangerous health risks. On today's episode, you'll hear how to best manage your potassium levels to protect yourselves.
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Dawn
Hi, my name is Dawn Edwards and I'm a 30 year kidney patient and I am here today to talk about potassium. With registered renal dietitian, Jessiana. How are you doing today?
00;00;57;27 - 00;01;12;04
Jessiana
Thanks for letting me be on here today. I'm really excited to talk with you. Talk about potassium. Big confusing miscommunicated topic for a lot of people. So I hope we can get some clarity and good ideas for people today.
00;01;12;27 - 00;01;34;16
Dawn
Yes, you're so right. You know, being a patient myself, it's been difficult at times to manage potassium. You want to eat the right things so that you can stay healthy. And sometimes we get the P’s confused, the phosphorus and the potassium. So it's really great that we'll be able to help some people out and give them some clarity today.
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Jessiana
Well, thanks for letting me be here.
00;01;36;13 - 00;01;50;01
Dawn
It's my pleasure. So let's jump right in, Jess. You know, let's start from the beginning. What is potassium and why does some people with kidney disease need to restrict potassium in their diet?
00;01;50;20 - 00;02;13;20
Jessiana
So potassium is one of our electrolytes. We think of electrolytes and we think of like Gatorade. And people are working out, you know, so it helps with our muscle firing and our our nerves so that they can work well, has a lot of really great functions. The reason potassium comes on the radar for people with kidney disease is because the kidneys help balance out.
00;02;13;20 - 00;02;35;22
Jessiana
The potassium in the blood is one of their core functions. And so if your kidneys aren't working well, you can start getting some imbalances. And for some people, especially later stages, it can build up and cause something called hyperkalemia. And hyperkalemia can cause your nerves and your muscles not to work right. Which in the hospital can be really quite dangerous.
00;02;36;00 - 00;02;50;16
Jessiana
It's really easily preventable. Once you know what to do. But that's really why it ends up being on the radar for people with kidney disease is so that they can manage their potassium levels and know how to make sure doesn't get too high.
00;02;50;23 - 00;03;11;11
Dawn
Wow. You know, that's that sounds like a really important mineral that you want to have balanced. I heard you say muscles and nerves and your heart is the muscle. And I know as a patient myself, I've had trouble with neuropathy. So that's something that's really important that we will want to manage. Yep.
00;03;11;23 - 00;03;36;15
Jessiana
Yep. The well and you know, there's a lot of different places where potassium plays into like muscle and nerve function. For people that are early stage kidney disease, not on dialysis yet. Potassium is actually a really helpful nutrient because it can help with blood pressure effort. It's really for some, not even everybody, but for some people on dialysis, you have to be mindful of how much does.
00;03;36;15 - 00;03;58;10
Jessiana
Yeah, it can. Too much could stop your heart and do it all. Also, if you're not eating hardly any at all cramps on dialysis and other problems like that can can come up for a lot of people. So, you know, it's not it's not it's a nutrient you need some of it's just if for some people they're not going to balance it, their kidneys aren't going to balance it well.
00;03;58;10 - 00;04;02;26
Jessiana
And so they may need to be mindful of what impact that levels in some of that food.
00;04;03;21 - 00;04;30;05
Dawn
Wow. That's really important information because I remember when I was in CKD, they would tell me to have a banana or have some orange juice and then when I started dialysis, I was told not to have those things anymore. So that's really important that we understand the difference between having the potassium before dialysis and having it when you're on dialysis.
00;04;30;05 - 00;04;32;17
Dawn
So that was really great clarification.
00;04;32;17 - 00;04;59;10
Jessiana
Jess and Dan just kind of hits onto that just a little bit. One thing that has been really neat in the to me, this is really neat. So I started working in dialysis like, I don't know, 15 years ago. And when I started and in my schooling they say, okay, like people with kidney disease that is, that don't have kidney function, they have to follow a low phosphorus, low sodium, low potassium diet.
00;05;00;05 - 00;05;03;23
Jessiana
However, what's really interesting is that the research.
00;05;03;26 - 00;05;04;23
Dawn
Actually.
00;05;05;08 - 00;05;36;25
Jessiana
Has not supported long term. The research has not shown that a dietary potassium restriction is the most impactful weight to control that number and so over time, what has happened is that if you look at the current research on the quote unquote renal diet, potassium, the recommendation now is that it is individualized as to the person's labs. That means that there are some people on dialysis that can eat a lot of potassium and there's some people on dialysis that need to eat a little bit.
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Jessiana
But it's individual for the person. It's not across the board. Like just because you're on dialysis or just because your kidneys don't work, you have to cut it out. And that is amazing because that has allowed a lot of people to increase the variety in their diet and add back in things that they thought were bad but truly weren't actually hurting.
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Dawn
So, Jess, I know we talked a little bit about individualized care and patients being patients being able to have a more diverse diet. I know when I started on home dialysis, potassium wasn't as much of an issue as it was previously when I was on in center hemo dialysis. So I understand what you're saying. So who is that?
00;06;23;20 - 00;06;27;27
Dawn
That really doesn't need that restriction. And why not?
00;06;28;02 - 00;06;59;29
Jessiana
Oh, man, this is a super good question. So there's a lot of different reasons why people may or may not need a potassium restriction. So just kind of overarching with the caveat that every single person, it is dependent on their lab period. So these are just kind of broad categories, but really very, very individualized. So for example, what you just said is a super good example for people on home dialysis because your diet lies in more frequently.
00;07;00;28 - 00;07;17;17
Jessiana
Probably most of them don't really need a potassium restriction anymore, or they can have less of one because they're going to be filtering out potassium more often. Now, again, it may not be everyone if you want to look at your labs because there's a lot of things that pertain to potassium other than food and how much you got.
00;07;17;22 - 00;07;42;23
Jessiana
So that's one. Another category of people that may not need as much of a potassium restriction are people that are on hemodialysis but then still have some residual kidney function. So maybe they're still urinating a good amount even though they're on dialysis to help clear out the toxins or whatever else. Those people may not need as much of a potassium restriction either.
00;07;42;27 - 00;08;09;10
Jessiana
This number two, same thing with peritoneal dialysis. They tend to have a more liberal diet. In fact, a lot of people on peritoneal dialysis actually need to be on a high because they lose out so much potassium. And then when you move before dialysis into the chronic kidney disease space, it really just depends. It just depends on people's functions, what medications they're on.
00;08;09;19 - 00;08;23;01
Jessiana
There's a lot of factors that play into it. But generally speaking, most people that are stage 1 to 3, they don't need a potassium restriction, stage four and five maybe. But again, depends on the person.
00;08;23;01 - 00;08;38;16
Dawn
That's really great information. Just so that means that us as patients should really consult our dietitians and members of our care team to help us to pick the right diet for us. Everyone is different.
00;08;38;23 - 00;08;57;09
Jessiana
Yeah, it really helps out to run it by someone. I mean, if you are proactively looking at your labs for yourself, you can look at your potassium when it comes up and see where it's falling. If it's less than five and it's consistently less than five, then you're in a good, normal range. But you kind of want to watch the trend.
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Jessiana
If you're less than three, if you're less than three and a half, that's really low. You may actually the more you can run it by your doctor. Right. Look like you don't need to really want to be. Looks like it's normal. And if they're up to date on the most recent guidelines, they can advise you with, what would be best for you and a dietitian is invaluable.
00;09;19;06 - 00;09;36;16
Jessiana
I got to give a shout out to my best that they're really helpful in being able to discern like, hey, like, it doesn't look like you need a restriction. Like, what do you want to add in and how much or maybe if you do have one food, what's the number one food you're missing and how much could you actually have?
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Jessiana
And I just that makes it somewhat more doable on a quality of life.
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Dawn
You're so right. That's one of the things that I learned through my dialysis journey is that the relationship with my dietitian was so important because I was able to make those food choices that were best for me. So that's good advice for all of our patients that are out there. It's empowering to be able to have those choices and to have that great relationship with the dietitian.
00;10;07;27 - 00;10;24;13
Dawn
That's really important that this is only a couple of hours out of our life, but most of our nutrition and our health and well-being comes from the things that we do when we're not in treatment. So that was a really great piece to add.
00;10;24;17 - 00;10;29;15
Jessiana
Yeah, that's really that's really, really. Yeah, that's really.
00;10;29;15 - 00;10;42;05
Dawn
Too. So yes, I've had some experiences that, you know, from time to time during my kidney journey with something called hyper choline. Leo Could you explain what that is?
00;10;42;05 - 00;11;09;06
Jessiana
So hyperkalemia is when you have too much potassium in your blood and when you get too much potassium in the blood, like I mentioned earlier, it really impacts nerves and muscle in particular. So some people have there's a lot of different ways people will describe the symptoms of it. But essentially, if your potassium is start to hit over like six and a half, seven, seven and a half feet, super dangerous.
00;11;09;06 - 00;11;33;19
Jessiana
And if your doctor saw that, you'd be immediately given an onslaught. So people immediately go to the hospital to make sure that that can get taken care of because it can be really, really dangerous and and stop your heart so that just a little bit about it I had a nurse analysis nurse wants to be described as me because like you said, it's kind of like a traffic jam, right?
00;11;33;19 - 00;11;49;29
Jessiana
Like you have all the potassium parties going through and then they get too many and then they just stop because they like it's a traffic jam, right? Traffic jam. That's it. That's exactly right. But I think it's a good image of thinking about you're not going to be able to move and your muscles to stop.
00;11;49;29 - 00;12;19;09
Dawn
Just I remember that experience and this was many years ago, but it was a really frightening experience. Like you said, I lost my muscle control and I had to go to the emergency room. Nowadays, from what I understand, when that when that potassium is elevated, they have binders for that. Now that can help to keep the potassium level balance or lower it if it's too high.
00;12;19;09 - 00;12;20;06
Dawn
Is that correct?
00;12;20;10 - 00;12;49;09
Jessiana
Yeah. So one of the newer medications that has come on the market in India since I started working in this field 15 years ago or so has been the potassium binders. They're generally utilized for patients to kind of run on the borderline, I guess. I hope the past, you just make sure it doesn't go over it probably added I don't know if this is your case when you have that high potassium they send you to the hospital and they had you drink the excellent.
00;12;49;10 - 00;12;50;27
Dawn
Yes immediately.
00;12;50;28 - 00;13;09;03
Jessiana
Yeah that that's does a typical treatment because it'll pull down the potassium super quick for kind of a if you're a patient where you have kind of a risk for it to go a little bit too high and frequently happens, it's not just a one time thing. Then some doctors will prescribe a potassium binder for their patient.
00;13;09;03 - 00;13;16;08
Dawn
Well, that's great information. Thanks, Jess. So you know what? How much potassium is okay to eat?
00;13;16;08 - 00;13;42;03
Jessiana
Well, it depends. Again, it depends on the person. If you don't need a potassium restriction, then again, I'd say more the merrier in some ways because the if you don't have a potassium restriction, the research that has been done on blood pressure and nutrients impacted. They saw that the best controlled blood pressure was not just from a low sodium diet.
00;13;42;28 - 00;14;09;07
Jessiana
The best control of blood pressure was a low sodium, high potassium diet. So for early stage kidney disease, for people that don't need a potassium restriction, having a potassium rich diet, which is a lot of fruits and vegetables. Right, which are good for you in a lot of other ways, too, is really one of the most powerful things that you can do for people that need a dietary restriction.
00;14;09;14 - 00;14;28;21
Jessiana
There's like kind of some standard ballparks that people will aim for, like 20 to 3500 milligrams a day. Honestly, in some ways it kind of arbitrary because you have to take that nutrient and go back to food. When I work with patients, what we typically do is we'll look at high and low potassium lists and we'll say, Hey, you need to be conscientious of potassium.
00;14;29;06 - 00;14;53;11
Jessiana
You're going to stick primarily with these low potassium foods on your portion size. And if you want to have something that's higher potassium, I'll get potatoes because there's a lot of caveats. But if you like potatoes or your favorite thing ever, there was my favorite foods. My dad's from Idaho like potatoes. So if potatoes are your favorite food ever, how are you going to fit that in?
00;14;53;12 - 00;15;13;22
Jessiana
Because it's not black and white. Like food is really black and white. Like you can't or you can't have it. How many potatoes can you have and how much can you have it? And are there ways that you can modify the potassium in the potato you're eating? And that's the conversation that needs to happen for people that are strictly tracking how much they can have.
00;15;13;27 - 00;15;35;26
Jessiana
That can be a good tool too, compared to where your lab source you're logging it in a food log and your dietitian looking at it to say, well, you know, I typically eat 3000 milligrams a day and my potassium runs around five and a half. So that's probably pretty close to where I need to be in a little time that high, because that this offer, I didn't actually record this food.
00;15;35;26 - 00;15;38;01
Jessiana
And so that's where I'm getting more potassium from.
00;15;38;14 - 00;16;09;28
Dawn
Wow, that's really great. That's empowering information for patients. You know, I started a plant based diet a few years ago and I noticed some really excellent results physically and initially my potassium went up a little bit and then which I talked to my dietitian about the types of of potassium foods that I should be eating. And we've made some adjustments and now I feel great as a result.
00;16;10;09 - 00;16;27;06
Dawn
But I know years ago if a kidney patient wanted to do a plant based diet, everyone was worried about not enough protein and too much potassium. So what do you think about a plant based diet for kidney patients?
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Jessiana
This is the hottest up and coming topic in the world and I want a lot of plant based diets. There are so many powerful.
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Dawn
Parts.
00;16;38;25 - 00;17;03;09
Jessiana
To them. They are totally doable with with how we think about phosphorus and potassium. Now it's we just don't think about a renal diet how it used to be like when you were a patient, the same diet you were taught then should not be taught now because it's not the same is totally different. It's very individualized. We haven't found any of those restrictions actually really made a difference.
00;17;03;14 - 00;17;17;13
Jessiana
It's like in the research. So you could totally do a plant based diet. If you're on dialysis, you can do on tons of benefits. People will see their phosphorus drop down. I was that the case for you to do see your phosphorus is.
00;17;17;14 - 00;17;32;25
Dawn
Absolutely all of my lab started to level off and I felt so much better because I didn't have so much meat in my diet, so easy to digest, and I just really felt an overall better sense of well-being.
00;17;32;28 - 00;17;55;29
Jessiana
Yeah, that's. And that's what people will notice when they get on a good, smart, nutrient dense, plant based diet is they'll be like, Oh, my phosphorus is down a little bit lower. Oh, like, I'm not constipated anymore from lots of produce. Like I said, my potassium goes down then because there's a link with potassium and constipation or I feel better after they ellipses.
00;17;55;29 - 00;18;23;29
Jessiana
I'm not getting as much fluid. So if you're doing a good nutrient dense plant based diet, you have a good variety. You totally can feel a lot better and it's very doable if you feel a nervous about it's kind of like what you said non you can start you work with your dietitian before and second I want to engage in a plant based diet to say awesome and they'll be like so excited they'll get like the like give you a hug if they could because they're so excited about that.
00;18;23;29 - 00;18;46;07
Jessiana
And then they'll talk you through like, what is this going to look like for you? What do you like? And it can help guide you. And then they'll probably get labs a couple weeks after you start just to do your point, make sure your potassium is okay. Do need to modify it just a little bit or like look at it, tweak it a bit so it works for you and that ends up working really smooth for a lot of people.
00;18;46;27 - 00;19;13;17
Dawn
That's exactly what happened between my dietitian and myself when I went to her for guidance on picking out a meal plan that was right for me. She was so excited when I said I was going to try the plant based diet and we sat down and we worked on it together and we picked out some great food choices for myself, things that I really enjoyed and things that were easy for me to prepare.
00;19;13;17 - 00;19;27;08
Dawn
So I guess the real main point here is for patients to talk to their dietitians and get that individualized care plan for meals that work the best for them and their blood.
00;19;27;16 - 00;19;44;14
Jessiana
Yeah, I think I think that can be 100% really, really helpful to have that relationship with that person and know that they're cheering you on and they're on your team. And I just think it makes a huge impact and sounds like it has for you, too.
00;19;44;24 - 00;19;57;19
Dawn
Absolutely. I feel great and I'm happy about the foods that are meeting. And again, my blood work is so much more improved now since I've changed my ways of eating.
00;19;57;27 - 00;19;59;05
Jessiana
Beautiful. Beautiful.
00;19;59;29 - 00;20;23;23
Introduction
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00;20;24;11 - 00;20;48;03
Introduction
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00;20;48;25 - 00;21;05;16
Introduction
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00;21;07;00 - 00;21;21;13
Dawn
So, you know, I just want to get some clarity for patients who are maybe struggling a little bit with maintaining your potassium level. Can you tell us what some examples are of high potassium food?
00;21;21;14 - 00;21;42;22
Jessiana
Sure. So if you've identified that your nutrition is one of the number one contributors, which is it isn't always. So just making that we always blame the food for some like other potassium type, they're noncompliant. I hate that phrase. Right now they're not. They're not. They're not eating the right thing. It's their fault.
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Dawn
That's right.
00;21;43;28 - 00;22;08;05
Jessiana
So much. We default to food. And I'll still start with you. High and low. Right. I truly, truly. Food is less often the culprit than other things. It can be a culprit for sure. I remember I had a patient and it was full featured. I had a really tough day. It was like a really cloudy day. And he went home and eat the whole bag of potato chips and he came in for dialysis.
00;22;08;06 - 00;22;35;23
Jessiana
Next thing we got labs and his potassium was went through the roof. I mean, that was just it was right. If it's kind of an ongoing issue, it's probably not just diet. However, I will say that diet can give you a bridge to help bring your potassium down if you're struggling with that. And so understanding, you know, the common ones that we eat in America that are high in potassium, things like potatoes are very, very common.
00;22;36;07 - 00;23;03;20
Jessiana
It can be a big contributor. Sweet potatoes. And I know these are potato products, but for some reason we don't always clump them in the same place. But French fries, potato chips match the taste. Those are all potato products. The root tuberous vegetables have quite a bit of potassium in them. Other things can have quite a bit of potassium that people tend to eat regularly can include oranges and orange juice.
00;23;03;21 - 00;23;32;21
Jessiana
Tomatoes, a lot of tomato products in America, whether it's spaghetti sauce or, I don't know, tomato things. We eat a lot of Italian type foods, but we love tomatoes. Right? Right. Mexican food A is going to really deep tomato paste in it. You're going to get quite a bit of potassium in that. Those are some big common ones this time of year because of seasonal fruits and vegetables, nectarines and peaches.
00;23;34;12 - 00;23;39;14
Jessiana
Probably most of us have sat down meat like four or five peaches when they're fresh in season and they're so good.
00;23;40;11 - 00;23;41;17
Dawn
Oh, Andy.
00;23;41;21 - 00;24;04;01
Jessiana
Yeah, people's potassium is up. A lot of the melons are pretty high. Watermelon is not based on a normal serving size, but it's easy to eat a lot of watermelon this time of year because it's good. So those are a few that are pretty high. Probably some other big contributors can be if people are not watching for it being added into foods.
00;24;04;01 - 00;24;30;00
Jessiana
Potassium is an additive into some foods. That would be one place that I would look is, well, coconut products, especially with Quito being hot is a lot of coconut products on the market for now, coconut water has a lot of potassium in it and those can be contributors as well. Those are a few. I mean, there's there's a lot, but there's actually more fruits and vegetables are low potassium.
00;24;30;00 - 00;24;48;21
Dawn
And that's really great information. You know, I have a lot of friends that are like of Caribbean descent and Spanish descent. So you said root vegetables, wood vegetables like yuca or plantains and beets. Would those be considered high potassium as well?
00;24;48;25 - 00;25;14;12
Jessiana
Yep. Yep, Don, that's a good point. I forgot bananas in the plantains. Yeah, the cassava or the yucca root and the and beets. Some of those good starchy root vegetables can be high in potassium. The good news is you can swap them all right. There's a ton of good swaps for some of those high potassium foods that work almost exactly the same.
00;25;14;13 - 00;25;33;14
Jessiana
So, for example, if you really love like a fried potato, this might contain them up or potato salad. We like to swap out radishes and not raw radishes, cooked radishes. And if you saute them up with a little bit of butter, they are so good and you get kind of that same texture. Turnips can work for a lot of people.
00;25;33;14 - 00;25;54;25
Jessiana
Also, turnips get a really bad rap. They cook nicely as a root vegetable. They don't have quite as much potassium. So you can make little swaps like that and make it a lot easier to still enjoy some of your favorite foods. Or you just like watered down is not the right word. But maybe you're going to do a half a portion of potatoes and half a portion of radishes.
00;25;54;25 - 00;26;03;06
Jessiana
For example, in a dish to have less potassium. But you haven't totally eliminated the product or the flavor that you wanted.
00;26;03;10 - 00;26;30;21
Dawn
Wow, that's really exciting to know. I know I love turnips and that's a real cultural dish in the African American community, so it's great to know that I can have those, even though I don't have a problem with potassium. But it's great to know that others can have them if they like them. Yeah. So let me ask you about like food labels.
00;26;31;01 - 00;26;46;11
Dawn
That's one thing that, you know, we're always told as patients to look at your food labels before you make your purchases. Now, how can we know about the potassium? Is that on the food labels? Oh.
00;26;48;16 - 00;27;14;08
Jessiana
I'm saying just a little bit. So there was a legislation that was in the place to put potassium on the labels, but it's quite misleading right now. Some labels are measured accurately and they'll tell you the amount of milligrams and you can utilize that, but not all of the time. So if it's like less than 2% of the daily value, then they don't they can list as zero.
00;27;14;10 - 00;27;35;08
Jessiana
So I run a dietitian group on Facebook and people will post products and be like, Whoa, I didn't know that these beans had zero milligrams of potassium. It says on the label. And we're like, well, like that's just inaccurate labeling right now because of course they have some potassium in them. But so I don't honestly feel like you can trust potassium on the labels right now.
00;27;35;08 - 00;27;55;12
Jessiana
Obviously, the truth, I think, is pretty misleading. You can look for it and I'm sure it will continue to improve. But right now it's a little bit misleading if it says zero mg it may or may not be accurate is what we've just seen from looking at it, which I think is terrible if you put on the label right or like don't have it on there.
00;27;56;18 - 00;28;16;08
Jessiana
So the better way to look at it, in my opinion, is there's two things is, number one, have a good idea of what foods are high and low potassium. And if you're not sure about that, the easiest way to do that rather than be like memorize the high and low potassium is just talk with your dietitian. This is what I typically eat.
00;28;16;10 - 00;28;38;21
Jessiana
Are there any high potassium foods that I typically eat that I should be aware of? Because then you're just becoming familiar with what you're already eating and she can help. I do the other thing and you do this with phosphorus too, but you can look in the ingredients on the label and see if they have a potassium additive in there, some food they do at the tap in there.
00;28;39;12 - 00;29;00;28
Jessiana
And I don't know off the top of my head how much that adds in part is milligrams into a food. But for me I would still avoid those ones unless it's like the best food in the whole world and can't live without it. It's most of them. But I would just avoid those and find a different product that I know they haven't added anything extra.
00;29;01;15 - 00;29;30;06
Dawn
Just you know what I think that we just pretty much identified the golden rule for nutrition is to check with your dietitian if you aren't sure, because like you said, those food labels can be so confusing and you could end up eating something that may not be the best choice for you. So I would guess that the best choice and the golden rule for us is if you aren't sure, check with your dietitian.
00;29;30;06 - 00;29;52;03
Jessiana
Yeah, they want to help those questions. For a dietitian with a patient, ask them, hey, can you help me understand this a little bit better of trying to learn it? That is so fun for us to be able to engage in a Hollywood way. Rather do that and select data points to share in our next clinic meeting. Like we were educators at heart.
00;29;52;03 - 00;30;22;16
Jessiana
Right? And we love that. And the cool thing is, as a patient and Don, you can tell me if this has been your experience as you as you start to learn more, you gain more independence in your choices and you gain more confidence. And so you don't feel I feel like when people start on this journey, right, whether it's the initial diagnosis or going into out dialysis, super scary because now there's like a bajillion things you feel like you have to be aware of to just stay alive.
00;30;23;02 - 00;30;46;03
Jessiana
And every step you take on asking the question and learning what's going to be helpful for you and what things you can do to be mindful in how you're living makes you confident. And then you can make choices, like make choices on like if I'm going to have this big bowl of potatoes, is it going to really impact me or not?
00;30;46;03 - 00;31;02;03
Jessiana
But you don't live every choice being in fear and that I feel like that is the essence of really, really, really good medical care is that people become independent in caring for themselves and as a patient being proactive for yourself gives you so much freedom.
00;31;02;03 - 00;31;24;24
Dawn
Yeah, you're absolutely, absolutely right. You know, when I was taught about what to look for and what my bloodwork was and how to read it and how to read my food labels, I became so empowered and it made me feel like I had control over this disease. Instead of the other way around. So what you said is absolutely right.
00;31;24;25 - 00;31;50;02
Jessiana
Yeah, nutrition is like the part of it is about how it nourishes our body and how we live with kidney disease. But the other part of it is just feeling empowered and like turning it on its head. I have control over what I choose to eat. No one else is choosing for me, right? I have control over what I choose to eat and I can have control over this situation.
00;31;50;02 - 00;31;53;16
Jessiana
And that to me, that's a really important part of health.
00;31;54;04 - 00;32;26;12
Dawn
Yeah, you know, it's definitely a good feeling to be able to make those choices on your own because of the knowledge that you've gained from the relationship that you have with your dietitian or because you can use the tools that you were given by talking to your dietitian. So there's a lot to learn, but in the long run, you feel so much better when you're able to make those choices and have the variety instead of feeling restrictive all the time.
00;32;26;18 - 00;32;26;29
Jessiana
Yes.
00;32;26;29 - 00;32;52;04
Dawn
So I remember when I first started on dialysis and I used to talk to my dietitian about not being able to eat potatoes. And that was a real big struggle for me. And she told me about reaching or soaking the potatoes before I cooked them. Could you talk to me a little bit about that? Do we still need to do that?
00;32;52;12 - 00;32;57;14
Dawn
Could you talk to me a little bit about what that process is and why do we need to do that?
00;32;57;14 - 00;33;28;12
Jessiana
So again, one of the classic recommendations for reducing potassium in tuberous vegetables, potatoes, butternut squash, nails, etc. has been to soak them. Now, the interesting thing about this, Don, is that some people actually chose to study this. I can't remember who the researchers are, but their studies are are really interesting. And what they found is that soaking the potatoes didn't really do much of anything.
00;33;29;15 - 00;33;57;15
Jessiana
It was it the effect that people thought that it would actually take out potassium? 90% of the potassium stayed in the potatoes. Now, what they did find and I'll tell you why this works really better, what they did find, however, is that double boiling them can remove. You know, it depends on how big a chunk of potato versus like shredded potato, but depending on the size of the piece, it can remove up to 50 to 60% of the potassium.
00;33;58;01 - 00;34;20;18
Jessiana
And the reason that there's a big difference there is that when you're soaking potatoes, you're just putting them in cold water only to sit there. And then we're expecting that the potassium is going to move inside the little potato cells out into the water that doesn't have potassium. And that doesn't happen when you heat up a potato and it gets soft.
00;34;20;18 - 00;34;47;02
Jessiana
Right. When it gets soft, what's happening is all those little potato cells, they're breaking. They're breaking down. And when those when those cells break down, it releases potassium into the water. And that's why you can remove a lot more potassium. So if you double boil them, you can remove a lot more potassium and you can save yourself from having to think so far ahead, three days ahead.
00;34;47;02 - 00;35;08;21
Jessiana
I got to soak my potatoes for three eight Thanksgiving. You just double boil them the day before. But the downside of that is, of course, that limits do a little bit on which products are going to be edible because you're not going to double boiled potatoes and then fry them because they'll just break. But you can double boil your potatoes and the mashed potatoes are super.
00;35;08;21 - 00;35;14;00
Dawn
Wow. Okay, great. So now I have a challenge for you, a challenging question.
00;35;14;07 - 00;35;15;28
Jessiana
Oh, I got Google here, so.
00;35;17;01 - 00;35;35;12
Dawn
It's easy, but can potatoes are already cooked and they're in water? What's the challenge with having canned potatoes and maybe just boiling them again after taking them out? The can.
00;35;35;28 - 00;35;53;06
Jessiana
Are? That's a good question. So it would still be the same principles when they can a potato. It's going to be a heated process. And I mean, can potatoes are soft, right? They're not hard. So they've already broken down some of that calcium. I would drain them and get you to boil. You could boil them again.
00;35;54;06 - 00;35;59;05
Dawn
Okay. So that's good to know. So canned potatoes can be done.
00;35;59;18 - 00;36;00;21
Jessiana
Yeah, I tell.
00;36;00;21 - 00;36;02;13
Dawn
You what, be careful of the salt.
00;36;03;15 - 00;36;21;24
Jessiana
Yeah, you can. Yeah, the they're going to slowly higher in sodium and you know, I don't actually know if I've ever smoked with canned vegetables. I grew like I my dad was from Idaho, right? Like there was no potato flakes, no camp. Like, we just eat the real deal.
00;36;22;15 - 00;36;32;08
Dawn
Yeah. You know, I live in an urban environment and access to fresh fruits and vegetables. I particularly noticed this during the pandemic.
00;36;32;14 - 00;36;32;26
Jessiana
Oh, you.
00;36;32;26 - 00;36;41;03
Dawn
Know, that was pretty difficult. And I know a lot of people depended on those canned goods. So that's why I wanted to ask the question.
00;36;41;10 - 00;37;00;09
Jessiana
It's a super good question. And you think even Don, like in a situation like the pandemic or maybe there's an emergency, what are you going to rely on? And you're going to need to use some of those foods that are preserved. And as long you know, you know what's in them, like you said, they might have a lot of salt to know how much salt that is.
00;37;00;09 - 00;37;08;26
Jessiana
And, you know, if you're bringing them, you're rinsing them just like beans, and then you're double boiling and you probably get some of that salt out as well. So that could be a perk.
00;37;09;07 - 00;37;23;22
Dawn
So that's great information. Oh, okay. So let me ask it this. We want to talk about blood pressure medication. This blood pressure medication contributes a high potassium.
00;37;23;22 - 00;37;43;13
Jessiana
It can if there is there is a class of meds, a blood pressure, medications that can raise your potassium levels if you're going to be starting a new blood pressure medication. If your doctor hasn't told you either way, a good question. You say, hey, is this going to impact my potassium? And they good luck to know either way.
00;37;43;13 - 00;37;50;18
Jessiana
Usually if it's going to end, you're kind of on the edge. And they would draw your lab soon after starting it to double check.
00;37;50;26 - 00;37;55;24
Dawn
Let me ask you this. What does potassium have to do with blood pressure anyway?
00;37;55;25 - 00;38;20;15
Jessiana
Well, this is a very chemical biochemistry. I, I tried to think what the easiest way is to describe it. Like I said at the beginning, higher potassium diet can help bring your blood pressure down on the most simple level. That is it. But beyond that, it's quite a slightly complicated about the restriction for pregnancy. I said.
00;38;20;22 - 00;38;32;22
Dawn
Okay, so can we talk about if you are having some issues with high potassium, what are some ways that are out now that can treat that high potassium?
00;38;32;22 - 00;38;58;06
Jessiana
So like we mentioned earlier, I think the best way honestly is to start off with working with a little dietitian only because before you default to another medication or or adding tons of dietary restrictions, if you can talk with the registered dietitian first, he can sort through here are the contributing factors that are coming into your potassium levels, like your blood sugars are way too high.
00;38;58;06 - 00;39;19;05
Jessiana
You're a little bit acidic. You're constantly like there's there's a whole bunch of things that can play in the high potassium, sort through that. And then instead of giving a blanket approach like, Oh, here's your high potassium, let's don't eat anything on that. That's what happens to a lot of patients, which is unfortunate. So you can talk with you and say, hey, let's talk about what to eat, okay?
00;39;19;06 - 00;39;40;22
Jessiana
Oh, you drink like one of my favorite things in the summer is both of them are all. You drink a ton of coconut water. Jess Well, that's probably a big contributor. So what if you just cut your portion down in half and you do lemon water instead or whatever? Then you have a really specific intervention that's going to make an impact.
00;39;40;22 - 00;40;01;24
Jessiana
And that doesn't mean you're giving up everything that you thought was healthy for you to eat. You're just really getting targeted. That's the first step. If you still cannot get your potassium down into a safe level after that point, then you would have a conversation. Talk with your doctor about potassium later, but I would always start at the higher level.
00;40;01;24 - 00;40;09;05
Jessiana
First was the actual cause of my high potassium before to add on the medication. I think that's honestly the best example.
00;40;09;05 - 00;40;28;09
Dawn
Yeah, that's that's great information and that's a really smart way of looking at it. So, you know, one of the things that I've had problems with during the course of my journey sometimes is constipation. So is potassium. Relate to that in any way?
00;40;28;09 - 00;40;55;18
Jessiana
It sure does. So you absorb potassium through your gut from all of the absorption spots. And when people are constipated, you are going to absorb more potassium than you would with the regular transit time through your gut. And the research is really good on that. But more constipation will link back to higher potassium levels. So again, if you're looking at your whole picture, instead of being like, I have to take all these fruits and vegetables, my potassium is too high.
00;40;56;00 - 00;41;29;20
Jessiana
That not only complicates the constipation issue, it will also attacked me with even more. And so that's where you want to go down to the public constipation issue, the potassium balancing. And on the high side, how can we resolve the constipation, not just keep pulling out these foods? Yeah, it's a really there's a really good link there. And I think it's a very important piece is often overlooked when people have high potassium is thinking about was potassium actually getting absorbed.
00;41;29;20 - 00;42;04;01
Dawn
Well you know just you've really given us some great information here on how to make wise food choices, the importance of talking to your dietitian, how to remedy high potassium if you do have it. And about really individualized care, which is really important knowing that every patient is an individual and we can't be all lumped together as one group of kidney patients.
00;42;04;11 - 00;42;22;18
Dawn
So I just really want to thank you for all of the great information that you've shared today. And, you know, before we end our discussion, I just wanted to know, did you have any final thoughts, anything that you wanted to share with patients that we didn't get a chance to touch on?
00;42;22;27 - 00;42;45;27
Jessiana
I think if I could give one takeaway to everyone here today is that if there is one especially nutritious food, like a fruit or vegetable, you're really missing and you have taken out of your diet to be a, quote unquote good patient, then go talk to your dietitian, go talk to someone and ask if you can add it back in.
00;42;46;17 - 00;43;12;24
Jessiana
Because I would put money on it like I'm 99.9% sure that favorite food that you miss, you could put back into your diet in some degree. And that to me is really important that people feel like they have that they can that they haven't sacrificed their life to the kidney disease, that they it all works together. I live with this.
00;43;13;01 - 00;43;35;19
Jessiana
I don't have to be a martyr for my cause. Here there are I can have lots of good things that I like and they can work in my diet and I can enjoy them and I can still be safe and healthy. So that would probably the one big takeaway is if there's something you've pulled out, you really missing, go talk to someone about it and see if you can get it back in your diet, because I think you'll find that you can fit it back in.
00;43;35;19 - 00;43;36;18
Jessiana
And that's the type.
00;43;37;18 - 00;44;02;24
Dawn
That is exciting. Jess So you know, just to sum it up, kidney disease nutrition today is not the same as it was years ago. We've evolved on a lot of levels. Who would have thought plant based diets would be something that could be great and something that a dialysis patient could introduce in their lives? And it's actually healthier.
00;44;03;25 - 00;44;28;22
Dawn
You know, it's been really great talking to you, Jess. I want to thank you for your time. Thank you for all of this great information. And I really think that we're going to be empowering a lot of patients today and also encouraging them to really utilize that great resource that we have in our renal dietitians. So thank you again for your time.
00;44;29;01 - 00;44;40;18
Dawn
I would love to talk to you again about potassium or about some of the other minerals that we may need to be considered in our diet.
00;44;40;20 - 00;44;53;25
Jessiana
So thank you, Don. Thanks for having me through. I thought it was really fun to chat with you and hear pieces of your story and bring that end and. I think that's important for everybody to feel empowered and not alone, but a lot of you can do to still enjoy your life.
00;44;54;04 - 00;45;15;15
Dawn
That that's so true. You know, kidney disease is not a death sentence. You can live and you can live well with kidney disease. You just have to utilize those members of the care teams that are there to help you and to guide you so that you can live your life feeling good and living good. That's just a note to everyone.
00;45;15;15 - 00;45;21;05
Dawn
Thank you all for your time and it's been great. Have a great day.
00;45;23;00 - 00;45;48;25
Introduction
As with every episode, we want to give a shout out to a kidney patient celebrating a major milestone. In 1993, kidney patient Tanner was lucky enough to receive the gift of life from her brother, Michael. 29 years later, her kidneys still going strong. Congratulations, Tina and Michael. Thank you for listening. Make sure to rate and review us on Apple Podcasts, Stitcher, Spotify, or wherever you listen to podcasts.
00;45;49;09 - 00;46;26;07
Introduction
You can also email us directly with your comments and suggestions and KFI podcast at Kidney Dawg. We hope you'll join us next time. And from all of us and chaos. We wish you good health.