Managing a low-potassium diet with traditional Latinx food

Managing potassium levels in the chronic kidney disease (CKD) population can be challenging, especially within a traditional Hispanic diet, which often includes high-potassium foods. However, is this as complicated as it seems? Studies on plant-based dietary patterns, like the Mediterranean diet or DASH, have shown these diets can slow CKD progression and lower mortality in patients with kidney disease and failure. Interestingly, the traditional Hispanic and Mediterranean diets share similarities.  

A traditional Hispanic diet typically includes staple foods such as corn, beans, rice, tortillas, potatoes, yams, legumes, plantains, squashes, tomatoes, avocados, and various fresh fruits and vegetables. Common proteins are often seasoned with herbs and spices such as cilantro, cumin, and chili peppers, emphasizing a balance of complex carbohydrates, proteins, and healthy fats while using fresh, minimally processed ingredients. Understanding these aspects is essential when assessing a Hispanic patient, and implementing cultural humility in nutritional counseling is necessary.  

Rather than focusing on specific nutrients, it is more effective in promoting healthy dietary patterns. For adults with CKD stages 3-5D or post-transplantation, adjusting dietary potassium intake is essential to maintain serum potassium within the normal range. In cases of hyperkalemia or hypokalemia in CKD patients, dietary or supplemental potassium intake should be tailored to individual needs and clinical judgment. Increasing dietary intake of fruits and vegetables is suggested to reduce net acid production (NEAP) in CKD stages 1-4, which can help slow the decline in kidney function.   

Common causes of hyperkalemia not related to diet  

Hyperkalemia in CKD patients can be influenced by factors beyond diet, such as:  

• Medications like ACE inhibitors, ARBs, and potassium-sparing diuretics  

• Hyperglycemia  

• Acidosis  

• Constipation  

Traditional Latinx foods and their potassium content  

Traditional Latinx cuisine includes many foods high in potassium, such as beans, plantains, avocados, tomatoes, and certain leafy greens. However, some variations, like the “Dieta de la Milpa” (a traditional Mesoamerican diet comprising corn, beans, squashes, and chilies), have shown potential benefits for Hispanic/Latino individuals with CKD. Research by Biruete et al. (2024) highlights the diet’s ability to support acid-base balance, manage protein and phosphorus intake, and influence gut microbiota, which can benefit CKD patients. On the other hand, evidence suggests that most Latinos do not meet the recommended potassium intake, with women averaging 2,069 mg and men averaging 2,649 mg.  

Practical tips for managing a low-potassium diet in the Hispanic diet  

Managing potassium intake is all about balance. If a patient presents with hyperkalemia related to diet, adjusting their diet instead of limiting it can be beneficial. For instance, a typical serving of black beans or a medium-sized avocado can significantly contribute to daily potassium intake. Dietitians should work with patients to identify high-potassium foods and choose lower-potassium alternatives or strategies to reduce potassium intake. Meal planning and portion control are essential for balancing high-potassium food sources and ensuring proper portions while still allowing high-potassium foods to be incorporated occasionally without exceeding daily limits. Here are some practical tips to teach our patients:  

• Choose products with lower potassium content by reading the nutrition labels and checking for ingredients like potassium chloride, potassium sorbate, tetrapotassium phosphate, and dipotassium phosphate.  

• Avoid low-sodium salt since it contains potassium chloride.  

• Double-boil starchy vegetables to help reduce potassium content.  

• Limit dairy to one cup daily.  

• Drain and discard liquids from canned fruit and vegetables.  

Adapting traditional Latinx recipes for a low-potassium diet  

Adapting traditional recipes is crucial for maintaining adequate potassium intake and cultural satisfaction. Here are some practical modifications:  

• Arroz con Pollo (Chicken and Rice): Use a base of onions, garlic, and bell peppers instead of tomato-based sauces.  

• Ceviche: Opt for lower-potassium fish like tilapia or shrimp and limit high-potassium ingredients like avocados to ⅛ medium size. Focus on lime juice, cilantro, and other herbs for flavor. 

• Sancocho: Replace high-potassium vegetables like potatoes and plantains with lower-potassium options like carrots, pumpkin squash, chayote, and leached potatoes/sweet potatoes.  

• Tacos: Substitute meat for beans. Beans are a great source of fiber and protein, so no additional proteins are necessary.  

• Flan: Use low-potassium milk alternatives like almond milk or rice milk.  

• Horchata: Prepare with rice milk or almond milk instead of traditional milk.  

• Pico de Gallo: Limit tomatoes while increasing the proportion of onions, cilantro, and lime juice, and add diced cucumbers for crunch.  

• Pasteles Puertorriqueños: Choose frozen yucca or rice as a base for the masa, which is lower in potassium than traditional masa.  

• Empanadas: Fill with lean meats and low-potassium vegetables like zucchini, celery, and mushrooms.  

Some dishes or sides can be part of a low-potassium diet if eaten in moderation and not combined with other high-potassium food items. Examples include tostones (fried green plantain), stuffed poblano peppers, nopales, avocados, chilaquiles, and pupusas filled with beans.  

Incorporating cultural humility in dietary management  

Cultural humility involves recognizing and respecting patients’ cultural food preferences while providing dietary guidance. It is essential to engage Latinx patients in discussions about their food traditions and preferences. Building trust with Latinx patients by showing respect for their cultural food preferences and understanding the need to avoid imposing rigid dietary changes without considering the patient’s cultural context is crucial. Involve patients in creating meal plans that incorporate their favorite traditional dishes with necessary modifications.  

Providing accessible resources and support is vital for successful dietary management. Always have bilingual educational materials and local resources on low-potassium diets and CKD management available.  

In essence, managing a low-potassium diet while honoring traditional Latinx foods requires a combination of cultural sensitivity, practical dietary adaptations, and patient education. By incorporating the latest KDIGO guidelines, recognizing common non-dietary causes of hyperkalemia, and respecting cultural food preferences, dietitians can help CKD patients maintain their health without sacrificing their cultural identity. Through collaborative and culturally sensitive approaches, patients can enjoy traditional Latinx cuisine while effectively managing their potassium levels. 

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References

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S)
–S314.  

National Kidney Foundation. (2024). Potassium and Chronic Kidney Disease. Available at: National Kidney Foundation.  

Rodríguez, J., Morales, R., and Pérez, M. (2023). Dieta de la Milpa: A Culturally-Concordant Plant-Based Dietary Pattern for Hispanic/Latine People with Chronic Kidney Disease. Nutrients, 16(5), 574. Available at: MDPI.  

Pyram, R., Kansara, A., Banerji, A., & Loney-Hutchinson, L. (2019). Chronic kidney disease and dietary management in Caribbean and African American patients. Frontiers in Public Health, 7, 162. https://doi.org/10.3389/fpubh.2019.00162