Diet for Patients with HyperKPP and PMC

Submitted by deb on Sun, 07/17/2011 – 21:14

This information is based on diet recommendations found in many medical journal and textbook articles about Hyperkalemic Periodic Paralysis. (HyperKPP). According to physicians and dieticians those with HyperKPP should follow a diet which is high in carbohydrates and low in potassium. Because muscle tissue is stressed in the periodic paralyses it is also essential that patients obtain liberal amounts of high-quality protein.

Drawing on my training as a nutrition instructor, and 45 years of feeding a husband who has both HyperKPP and Paramyotonia Congenita I’ve designed a diet for HyperKPP. This article begins with information which explains the rationale behind the diet to those who may be learning how to manage HyperKPP.

What is “Blood Sugar” and Where Does It Come From?

Blood sugar, also known as blood glucose, is the body’s fuel. It feeds the brain, nervous system, muscles and other tissues. The body makes glucose from the carbohydrates, proteins and fats we eat. We would not be able to function without glucose.

As food is digested it is converted to glucose which is released into the blood. Some glucose is stored in the liver, as insurance against low blood sugar. Maintaining a stable blood glucose level is important to everyone’s health and performance, but it is absolutely essential to those with Hyperkalemic Periodic Paralysis and Paramyotonia.

How Blood Sugar Level Affects Muscle Strength

After eating, blood sugar rises, and glucose begins to move into the muscles. The pancreas produces a hormone called insulin which allows glucose to move into the tissues, including the muscles. The higher the blood sugar rises the more insulin is produced, the more glucose moves into the muscles, and the faster it moves. As each molecule of glucose enters the muscle it takes an ion of potassium (K+) with it, lowering the amount of potassium in the blood serum.

Blood sugar fluctuations are a common trigger for Hyperkalemic episodes

The brain is very sensitive to low blood sugar. When blood sugar drops too low the body protects the brain by releasing a form of glucose from the liver. The effect of this glucose release is the same as drinking syrup! K+ moves into the muscle, dropping the serum potassium level. This mechanism is used as a management tool in HyperKPP to reduce serum K+ at the first sign of weakness. Patients are often counseled to drink a heavily sugared beverage, take several spoonfuls of corn syrup, or eat candy at the first sign of weakness. In other words they are told to ingest a large amount of a simple carbohydrate to abort a developing episode.

While this strategy works well to begin with, I have observed its consequences in numerous patients over the course of the last 15 years, as Co-Manager of the HKPP Listserv. Patients find themselves on a “blood sugar roller coaster”. They must keep increasing the amount of simple carbohydrate to get the same result, and they must take it more often. This constant siege of simple carbohydrate causes them to gain weight, and over time they become insulin resistant, and develop Type II diabetes. Some then need diabetes medication or even insulin to bring down serum potassium levels, with all the difficulties and expense of frequent blood glucose monitoring, the danger of dropping insulin too low, and increased stress on all their organs.

On this website we will discuss a more sensible approach to management, one which will not cause more harm than good over the long run.

How Much Potassium per Day?

The best management plan for HyperKPP is to eat a balanced diet low in potassium, with a moderate amount of healthy fat, and generous amounts of complex carbohydrates and protein. A potassium intake of 3,500 – 4,000 mg daily is recommended for normal people. A total of no more than 3,000 mg daily is a good goal for the person with Hyperalemic PP. If you are on a diuretic which makes you excrete potassium, talk to your doctor about potassium intake.

Portion control is important. It’s best to avoid large meals, even of “good” foods, but you must never allow yourself to become overly hungry, and large portions of low potassium foods equal small portions of potassium rich foods. The goal is to eat just enough to satisfy your hunger at mealtimes, and have a snack mid-meal. This will keep blood glucose stable and avoid precipitous ups and downs in serum potassium.

Foods that should be included in the daily diet

These are proteins, plus fruits and vegetables which are both high in complex carbohydrates and low in potassium.

Foods to be used in limited amounts

Simple carbohydrates and foods somewhat higher in potassium, but necessary to maintain both a balanced diet and furnish the higher carbohydrate intake required by the HyperKPP patient.

Foods to omit from the diet

Foods high in potassium.

What does “Carbohydrate” Mean?

Carbohydrates are organic compounds found in living tissues. They contain hydrogen and oxygen, plus starch, sugars and cellulose (fiber).

There are three simple carbohydrates; Glucose; Fructose and Lactose. Glucose is the only form which can be used as fuel for muscles, brain and organs, so it is a simple carbohydrate. Fructose and Lactose must be digested and broken down into glucose before they can be used by the body, so they raise blood sugar more slowly than glucose, and are thus more complex.

What Foods Have Carbohydrates in Them?

Glucose is found in grains and vegetables. Fructose is found in fruit. Lactose is found in milk and milk products. On food labels carbohydrates are the listed ingredients ending in the letters – OSE, including but not limited to: Glucose, sucrose, fructose, dextrose and maltose.

HyperKPP Diet Principles

All patients with HyperKPP should drink an adequate amount of fluid every day, as dehydration is very likely to bring on symptoms. Water is the very best drink, with green tea a close second. Coffee is high in potassium and should be limited to no more than one or two cups a day. The free use of sugar is to be avoided. Sugar substitutes Equal, Splenda and Stevia may be used as desired.

The diet should be low in sodium, no more than a tsp total daily. Watch for the sodium content on food labels. Foods that have less than 140 mg or 5% of the Daily Value [DV] of sodium are low in salt.

Get Your Protein!

Protein is your friend, as it helps keep blood sugar levels stable. Each meal and snack should include a a small portion of protein, however many proteins contain a lot of potassium, so don’t overindulge. For health reasons, choose lower fat cooking options, i.e. broil, grill or poach rather than frying.

Eat 6–7 small servings per day. One serving of the size indicated below contains 8 g of protein and 120 mg of potassium. These proteins contain no carbohydrate. Weigh meat, fish, and poultry after cooking, without bones or visible fat.

Food and the serving size:

Bacon, unsalted – four strips
Beef – 1 oz (30 g)
Cheese, cottage or ricotta – ¼ cup
Cheese – 1 oz (30 g)
Chicken, turkey or other poultry –1 oz (30 g)
Egg – 1 large
Egg substitute –1/4 cup
Oysters – 3 oz (100 g)
Fish or shellfish – 1 oz (30 g)
Tuna or salmon (canned or fresh) – 1 oz (30 g)
Game meat – 1 oz (30 g)
Lamb or veal – 1 oz (30 g)
Liver or other organ meats – 1 oz (30 g)
Peanut butter – 1.5 tablespoon daily
Pork – 1 oz (30 g)
Tofu – 3.5 oz (120 g)

Proteins to Avoid

Pinto beans
Soybeans and soy products
Dried beans and peas
Sunflower seeds and nuts
Imitation bacon bits

Milk and Dairy Products

Choose two servings per day – One serving contains 4 g of protein, 60 mg of sodium, 175 mg of potassium and 6 g of carbohydrate.

You may substitute one–half meat serving for one milk serving, but DO NOT substitute milk for meat. Of course you may also use ¼ cup of four choices, rather than ¼ cup of two choices.

Food and amount of one serving

Milk (whole, low-fat or skim) ½ cup
Evaporated milk – ¼ cup
Powdered milk – 2 tbsp
Coffee cream – ½ cup
Half and half – ½ cup
Ice cream – ½ cup
Pudding – ½ cup
Sour cream – ½ cup
Whipped cream – ¾ cup liquid/ 1.5 cups whipped
Yogurt (regular or frozen) – ½ cup


Soy milk or soy cheeses
Instant breakfast drinks

Fruit Exchange List

Choose 3 servings per day. One serving contains 1 g of protein, 155 mg of potassium and 10 g of carbohydrate. Use fresh or unsweetened canned or frozen fruit and juices. Juice-packed fruit should be drained; the juice can be used as one serving of fruit juice.

Fruit and amount for one serving

Apple – 1 medium
Apple and other juices – ½ cup
Applesauce – ½ cup
Blackberries – ½ cup
Blueberries – ½ cup
Raspberries – ½ cup
Cantaloupe – ¼ cup
Cherries – 10
Coconut – 2 tablespoons
Dates – 3 medium
Figs, canned – 3 medium
Fruit cocktail – ½ cup
Grapefruit, orange, prune and tangerine juice – ¼ cup
Grapes – 15
Honeydew – ¼ cup
Kiwi – ½ medium
Lemon – 1 med
Lime – 1 large
Mango – ¼ cup
Papaya – ¼ cup
Peach or pear – ½ cup canned
Peaches or pears fresh – ½ medium
Pineapple – ½ cup
Plum, red – 1 fresh
Plum, prune–type – 3 fresh
Plums – 3 canned
Pomegranate – ½ medium
Prunes – 2 large; Raisins – 2 tbsp
Rhubarb – ¼ cup
Watermelon – 1 cup
Use caution with these high-potassium fruits: Bananas; Strawberries; Oranges; Tangarines, Grapefruit.


Avocado and dried fruits not listed above; Sweetened, canned and frozen fruits and juices.


Choose four servings per day: One serving contains 1 g of protein, 5 mg of sodium, 155 mg of potassium and 5 g of carbohydrate. Use fresh vegetables, frozen vegetables without salt or unsalted canned vegetables. To reduce the potassium in cooked vegetables, cook in a large amount of unsalted water, drain and discard the water. Potatoes should be peeled, diced, boiled and drained to reduce potassium content, and limited to a single serving daily. Check tomato juice to make sure it doesn’t have potassium added to preserve color. Two tbsp of celery, onion or green pepper a day can be used in cooking without counting it as a vegetable in your meal plan.

Vegetable and amount in one serving

Asparagus – 4 spears or ½ cup
Bamboo shoots – ¼ cup
Beans, green and wax – 1 cup
Bean sprouts – ½ cup
Beets – ½ cup
Beet greens – ¼ cup
Broccoli – ¼ cup
Brussels sprouts – 3
Cabbage – ½ cup
Carrots – ½ cup
Cauliflower – ½ cup
Celery – 1 stalk or ½ cup
Chard – ¼ cup
Collard greens – ¼ cup
Corn, canned or frozen ¼ cup
Corn on the cob – three inch section
Cucumber 1 cup or ¼ large
Dandelion greens – ¼ cup
Endive or escarole – 15 leaves or 1 cup
Eggplant – ½ cup
Kale – ½ cup
Kohlrabi – ¼ cup
Leeks – 2 (five inch long)
Lettuce – 1 cup
Mushrooms – 5 medium
Mustard greens – ½ cup
Okra – ½ cup
Onions, green – 4 med
Onions, white or yellow – ½ cup
Parsnips – ¼ cup
Peas, green – ¼ cup
Pepper, green – 1 med
Potato – ½ cup
Pumpkin – ¼ cup
Radishes – 6 med
Rutabaga – ½ cup
Spinach, cooked – ¼ cup
Squash, (hubbard, boiled or acorn) – ¼ cup
Squash, (zucchini, crook– or straight–neck) – ½ cup
Tomato – ½ med
Tomato juice – ¼ cup
Tomato paste – 1 tbsp
Turnip or turnip greens – ¼ cup
Water chestnuts – 5


Baked potatoes; Baked acorn squash or butternut squash; Dried peas or beans, lentils, lima beans, chick peas or garbanzo beans, baked beans or any other beans or peas not listed above; Pumpkin seeds; Vegetable juice cocktail; Vegetables prepared in sauces; Stews and vegetable soups unless the vegetables have first been diced, cooked in water and then drained to reduce potassium content.

Bread And Grains

Eat two-three servings daily from this list. While whole grains are better for you, due to their fiber, vitamin and mineral content, “white”: bread contains a high level of glucose which raises blood sugar quickly which can be used to advantage. Whole-grain bread has the same amount of glucose, but the fiber content slows the rise of bread sugar. If you have some potassium allowance left choose a smaller serving of whole grains over refined, “white” baked goods.

Each item listed has about 15 grams of carbs and 100 mg potassium.

1 slice of white bread
1 small hamburger bun
1 biscuit or 1 roll
1 small piece of cornbread
2 graham crackers
½ cup cooked white rice or rice or wheat pasta (noodles, spaghetti, macaroni)

If you can find glutinous rice it is potassium-free, so may be used to boost carb intake without increasing potassium intake.

Foods which may be used in limited quantities to increase carbohydrate content of diet

Choose ONE serving daily from the following list:

Two tbsp syrup (as on pancakes, waffles or bisquits)
1–2 tsp honey in tea or on bread
1 tsp jam or jelly
½ sweet roll
1 doughnut or ½ cup ice cream (in exchange for one item in grains list)
¼ cup jello
two cookies
½ cup Cream of Wheat
2 x 2 inch (5 x 5 cm) square of cake
1 small pastry
½ cup instant oatmeal
½ cup glutinous rice
½ cup frozen or canned fruit with sugar added.

Meal Planning

Menus are easy to plan.

Each meal or snack should contain:

  • a serving of protein as indicated from the list above
  • 1 serving of vegetables or fruit as indicated from the list
  • 1 bread or grain exchange
  • ½ to 1 milk/dairy exchange from list

So the daily menu is built something like this, though all elements except protein can be moved from one meal to another.

  • Breakfast: protein + fruit exchange + milk
  • Mid-morning snack: protein + fruit exchange
  • Lunch: protein, 1 vegetable + bread exchange
  • Mid-afternoon snack: protein + fruit + bread exchange
  • Dinner: protein, 2 vegetables + milk + bread exchange + dessert
  • Evening snack: protein + 1 vegetable + milk

Breakfast Ideas:

Breakfast One

  • Scrambled egg(s)
  • ½ grapefruit (fruit exchange)
  • 1 biscuit (bread exchange)
  • 4 oz (120 ml) of milk
  • Coffee or tea
  • Sweetener

Breakfast two

  • ½ c apple sauce (fruit exchange)
  • Scrambled egg(s) with mushrooms
  • 1 slice toast with butter (bread exchange)
  • Coffee or tea
  • Sweetener

Breakfast three

  • ¼ c cottage cheese (fruit exchange)
  • 1 slice toast with butter (bread exchange)
  • ½ cup canned peach slices
  • Coffee or tea
  • Sweetener

More than cereal and eggs!

You can eat anything for breakfast. Low sodium cottage cheese with fruit is a nice choice in the summer. A minute steak is great for breakfast, with a small serving of hash browns, and a serving of berries or grilled mushrooms. How about a tuna melt on whole wheat toast with a fruit cup?

Snacking is good!

Mid-morning, mid-afternoon & before bed, a snack will keep blood sugar stable. Typical snacks might be:

  • 1 oz (30 g) of cubed Swiss cheese with an apple or small pear;
  • A boiled egg and celery/carrot sticks with ranch dressing dip;
  • Celery sticks with peanut butter or cream cheese filling, milk.
  • Cubed chicken, cherry tomatoes & ranch dip.
  • Tea and ½ cup of of vanilla pudding.

Lunch Suggestions

Sliced deli roast beef on a bun with mustard or catsup, lettuce and tomato, pickles and onions; cup of watermelon, and ten corn chips.

Salad of cold turkey or chicken; carrots, cucumber, green pepper, on lettuce or mixed greens, onions and salad dressing.

Fish, poultry or lean red meat, 1 slice bread, 1 serving of broccoli, 1 fruit exchange.

Rice wraps filled with bean sprouts, chicken, grated ginger, slivered carrot and celery, spicy dipping sauce.

Ringing the dinner bell!

Try these suggestions:

Baked chicken breast, ½ cup herbed rice, peas with butter, cole slaw; dressing: 1 tsp mayo, 1 tsp vinegar & ½ tsp Splenda, 4 oz (120 ml) milk, 1 serving strawberries.

Steak, mashed potatoes, carrots, celery sticks with cream cheese, tea.

Ginger-lime marinated chicken breast, broiled or grilled, cottage-cheese stuffed tomato, steamed broccoli, 1 bread exchange.

Lessons we’ve learned

Make dietary changes over weeks, rather than days. People come in different sizes and metabolisms and have differing caloric requirements. If the quantities of food described are not sufficient to keep you from being hungry choose lower potassium foods, and/or higher carb foods, to supplement the diet. Always use common sense.