Pondering the Perils of ---- Potassium??!!??!!!??!?

When I was first diagnosed with heart failure, my friends and family thought that I had a big advantage in that was careful about what I ate.  Other than a passion for salt, which I immediately went cold turkey on, my diet was excellent.  I didn’t eat red meat, I followed a low fat diet, and I ate a lot of fruits and vegetables. 

So who would have ever dreamed that there was something lurking in fruits and vegetables that could wreak havoc on a heart patient?  Potassium sounds so good for you – how could it cause any harm?
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Maybe I should have paid more attention to some of the warnings on my medication labels and a warning that my cardiac nurse gave me early on.   She told me to avoid salt substitutes because some of them contained a lot of potassium.   I didn’t’ stop to ask what the issue was with potassium.  I didn’t need a salt substitute, and I didn’t particularly like them, so it seemed like easy advice to follow. 

The first time I can recall that I crossed the potassium warning threshold was in the summer of 2016.  The test showed that my potassium level was elevated.  The doctor suggested that I reduce my daily dose of spironolactone from 25 mg to 12.5 mg.  The reason for this instruction was that spironolactone is a “potassium sparing” diuretic.  This drug is also used to treat low potassium levels and conditions in which the body is making too much of a natural chemical known as aldosterone.  I have friends and family with this issue.  But we had clearly established that a shortage of potassium was not my issue. 

I found out that the lowest dose that spironolactone comes in is 25 mg.  Fortunately, I have a pill cutter and so I have been able to just cut the pill in half.  As I recall, I redid the blood test after making this adjustment and the levels were okay.

In January 2016, I had some blood work performed as part of my annual physical.  Again, my blood work showed that my potassium level was slightly elevated.  According to the report from my primary care doctor, the normal range of potassium is 3.5 to 5.2.  My reading was 5.3.  So my primary care doctor suggested that I reduce my consumption of bananas, potatoes, asparagus, and avocados.  This is because these are foods that have a high amount of potassium.   Swell – bananas, potatoes and even asparagus are regular parts of my diet.  But being a good patient, I followed the doctor’s instructions and reduced my intake of these foods.  I also had another blood test in three weeks.  This time all my readings were in the normal ranges. 

With two instances of elevated levels of potassium since the summer of 2016, I thought it was important to find out what the issue was.  Here is what Harvard Medical Publications says about potassium and heart failure:

“Your body depends on the mineral potassium to help control the electrical balance of your heart as well as metabolize carbohydrates and build muscle. Low potassium levels can cause muscle weakness and heart rhythm disturbances. On the other hand, too much potassium can cause dangerous heartbeat irregularities and even sudden death. If you have heart failure, you need to pay close attention to how much potassium you get each day. What's more, some heart failure drugs can cause your body to excrete too much potassium, while others can cause your body to retain too much potassium.”

Yikes!  I certainly did not want my heart to get any weaker.  I also did not want to experience heart rhythm disturbances or heartbeat irregularities – especially the type that could cause sudden death. 

I was not happy that after the reductions in foods with potassium, my follow-up blood test reflected that my potassium level only decreased to 5.1.  Seriously?  I expected that with the cuts I made, my blood test would have showed more than a .2 reduction in my potassium level.  It was really discouraging that a big portion of my diet – fruits and vegetables – had healthy levels of potassium in them.  So with heart issues, I needed to cut salt, fat, red meat – and now some fruits and vegetables?  I was beginning to think that the only things safe for me to eat were the packaging materials that food came in.

While I appreciated that my doctor suggested cutting out certain foods because they had higher levels of potassium, it dawned on me that I might need to watch out for other foods with potassium in them.  You see, my diet includes such a large portion of vegetables that possibly consuming large portions of those with even those lower levels of potassium could impact my potassium reading. 

Right after this series of blood tests were performed, I had a regularly scheduled appointment with my heart failure doctor.  I e-mailed one of the nurses and asked if during the appointment I could get advice on a good number of milligrams of potassium to aim for in my diet.  Much to my surprise, I learned that there was a nutritionist on staff, and her services are part of the care that the office provides to their patients.  (Tip for chronic illness sufferers.  If you have diet issues, check with your health care providers to see if they have nutritionists on staff.  They can be a Godsend).    

When I met with the nutritionist, I explained that I was looking for some guidance in how much potassium I should aim for each day, and whether there were any foods I should avoid.  She confirmed that even low potassium foods could raise your levels if you ate huge portions of them.  She gave me these wonderful handouts that listed whether a particular fruit or vegetable was high, moderate or low in potassium.   We talked about a level that I should aim for, and also gave me her business card in case I had any questions. 

After talking to the nutritionist and to several of the nurses, I learned that there are a number of things that could skew the potassium results during a blood test.  In my case, the levels were just very slightly elevated.  So while I should be conscious of potassium intake, I shouldn’t go nuts in cutting it out because obviously a low amount of potassium in your system is problematic too. 

I suspect that the bottom line in potassium intake (as with anything in my current life) is that I have to be focused and flexible.  I cannot ignore that my diet has an impact on my life, but I should not be obsessed by this.  So happily, I am not looking at potassium as being perilous any longer.  It is neither an irrelevant substance nor is it a substance that is lethal.  It is just something else that I have to monitor.