The Role of Diet in HypoKPP

The Role of Diet in Hypokalemic Periodic Paralysis

High Potassium, High Protein, Low Carbohydrate Diet

The general dietary guidelines in HypoKPP call for a high potassium, high protein diet, low in simple carbohydrates and sodium. The goal is to maintain as stable a blood sugar level as is practical. It's recommended that large meals be avoided, with the food portioned out and eaten in six smaller mini-meals over the course of the day, rather than in three large meals. This keeps insulin and blood sugar levels on a more even level.

The goal is to maintain a stable blood sugar

Knowing how insulin affects the cell is important to management. People with HypoKPP must stay away from foods which cause blood sugar levels to rise rapidly. When blood sugar levels go up very fast, for example after you have eaten food containing sugar, there is a vigorous release of insulin from the pancreas. The insulin rushes out, attaches to molecules of sugar and moves them into the muscle cells, where they can be used as fuel. But as the glucose moves into the muscle it carries along potassium, causing an imbalance between the amount of potassium in the muscle and blood.

It is important to maintain a stable blood sugar. Not only can carbohydrates (foods containing sugars and starches) trigger episodes, but eating too much food at one time can also trigger an episode. Becoming too hungry triggers episodes in some people with PP, because when the blood sugar drops too low the liver will release stored blood sugar which triggers insulin release. But for people with HypoKPP many food-triggered episodes revolve around eating carbohydrates. This is why people with HypoKPP need to understand what carbohydrates are and how they should be incorporated into the diet.

What are Carbohydrates and Where are They Found?

Carbohydrates are found in starchy or sweet foods. On package labels they are the ingredients which end in the letters - OSE glucose, sucrose, fructose, dextrose and maltose.

Carbohydrates are found in:

grains (All breads, pasta, grains and cereals)
fruits
vegetables
root crops (potatoes, sweet potatoes, and yams)
beer, wine, and some hard liquors
desserts and candies
most milk products, except cheese

The old recommendation was that the HypoKPP patient eat no more than 85 grams of carbohydrate a day. This is an extremely limited amount and would probably not even be considered healthy today, given current knowledge. Carbohydrates must still be limited. But not all carbs are created equal. A peach contains carbs, and so does a Mars bar, but it shouldn't take a rocket scientist to figure out that you could probably eat several peaches in the course of the day without incident, but eat several Mars bars and you'd better book a suite in the ER, because you'll probably be needing it.

We have had people come to us who have given up vegetables due to the carb content, but still sit down to a dish of ice cream and cake after dinner and can't figure out why they still wake up paralyzed - since they have given up carbs! I hate to break the news, but as one fellow on our Listserv said, "If it tastes good, spit it out." (Oh, it's not actually that bad, unless you want to live on ice cream, which some days sounds very tempting.)

But all Hypos should know how to count carbs and choose the healthiest types of carbs for them. It is as important for the person with HypoKPP to know about carbohydrates, glucose and blood sugar as it is for a diabetic.

What is the Glycemic index?

The glycemic index is a tool that measures how fast a particular food will raise your blood sugar and trigger insulin production. The factors which determine the glycemic index are the structure of the simple sugars in the food, the soluble fibers the food contains and the fat content.

Complex carbohydrates must be broken down into glucose before they can be absorbed into the bloodstream. Complex carbs contain one of three common simple sugars; glucose, fructose or galactose. Glucose is found in grains (breads, cereals, pasta, baked goods etc.) and in vegetables. Fructose is found in fruit. Galactose is found in dairy products.

While all three of these are absorbed quickly by the liver, only glucose can be released immediately back into the bloodstream. Fructose and galactose must be processed and broken down into glucose in the liver before they can be released into the bloodstream, which slows their entry. This explains why fruit is lower on the glycemic index than grain-based foods which are rich in glucose.

Fiber slows digestion of carbs

Fiber, which is non-digestible carbohydrate, has no direct effect on insulin release, but it does serve to slow the entry of the the simple sugars into the bloodstream.

If we use white bread as the benchmark and assign it the number of 100, and measure foods by hat standard, here's how a selection of foods compare to white bread as rapid inducers of insulin production.

WHITE BREAD = 100%

Foods which score Greater than 100%

Grain-based foods:
Puffed Rice, corn flakes, puffed wheat, millet, instant rice, French bread

Root Crops:
instant mashed potatoes

Simple sugars:
Maltose, glucose

Snacks:
Tofu ice cream, puffed rice cakes

Glycemic Index Between 80 - 100%

Grain-based foods:
Grape-nuts, whole-wheat bread, rolled oats, oat bran, white rice, brown rice, muesli, shredded wheat

Vegetables:
Carrots, parsnips, corn

Fruits:
Banana, raisins, apricots, papaya, mango

Snacks:
Ice cream (low-fat), corn chips, rye chips

Moderate Inducers of Insulin Production- Glycemic Index Between 50-80%

Grain-based foods:
Spaghetti (white and whole wheat), pasta, pumpernickel bread, all-bran cereal

Fruits:
Orange

Vegetables:
Peas, kidney beans (canned), baked beans, navy beans

Simple sugars:
Lactose, sucrose

Snacks:
Candy bar, potato chips

Reduced Inducers of Insulin Production-Glycemic Index Between 30-50%

Grain-based foods:
Barley, oatmeal, whole grain rye bread

Fruits:
Apple, pears, grapes, peaches

Vegetables:
Kidney beans, lentils, black-eyed peas, chick-peas, pinto

Dairy Foods:
Milk, yogurt

Very Low Inducers of Insulin Production-Glycemic Index Less Than 30%

Fruits:
Cherries, plums, grapefruit

Vegetables:
Soy beans

Snacks:
Peanuts

How Much Protein Do I Need?

Protein is essential to life. It is part of every cell in your body. It is the raw material your body uses to makes the enzymes which are critical for the function of every system. It is necessary for the production of neurotransmitters which affect your mind and mood. Protein and fat are the base materials of the immune system. Without protein there can be no life. You cannot make protein. You must eat protein every day in a sufficient quantity to replace daily losses.

A diet high in protein is also essential to episode control. While the unaffected person would normally eat the amount of protein that would cover the palm of the hand at each meal, this is altered somewhat for the person with HypoKPP. For example, the two eggs at breakfast an unaffected person might eat would be reduced to one and supplemented with a high protein snack at mid-morning for the person with HypoKPP.

Remember that ay time you make dietary changes that you should do so gradually. Don't make drastic changes in your diet all at once. Change one thing at a time and give your digestive system time to adjust.

To figure out how much protein you should be eating a daily basis :

Multiply your body weight in kilos by 0.8 - 1.2 grams.
Or
Multiply your body weight in pounds by 0.36 - 0.6 grams.

Those who are in perfect health and physically fit use the lower figure. A person who is under physical or emotional stress, is preparing for surgery or recovering from surgery, is pregnant or nursing, is ill or recovering from illness or is weight training, or otherwise training for athletic competition would use the higher number.

A healthy man, 160 lbs./72.7 kilos, exercising regularly with no health problems would need 58 grams of protein per day. That works out to about 19 grams per meal (if he were eating three meals of equal size per day). If stressed or ill the calculation might go as high as 87 grams per day. See the work of Barry Sears and the Zone Diet for an in-depth discussion of protein.

You need a protein source such as fish, poultry, meat or cheese at lunch and dinner, and at each of the between meal snacks. Remember that bacon, hot dogs, 'lunch meats' and similar products do not count as healthy sources of protein. They are high in saturated fat, high in salt and high in chemical preservatives.

Here's a List of the Protein Content of Common Foods
Egg	6 gm Each
Lean meat, fish, poultry	25-30 gm per 3 & 1/2 oz
Tofu	20 gm per 8 oz
Temph (a soy product)	30 gm per 8 oz
Milk	8-9 gm per 8 oz
Soy Milk	6-9 gm per 8 oz
Yogurt	8-10 gm per 8 oz
Cream Cheese	2 gm per oz
Cheddar/Jack	7 gm per oz
Parmesan	0 gm per oz
2% Cottage Cheese	31 gm per 8 oz
Nuts and seeds	2-3 gm per Tbs
Rice, cooked	5 gm per 8 oz
Bulgar, cooked	8 gm per 8 oz
Oatmeal, cooked	5 gm per 8 oz
Wheat germ, toasted	8 gm per 1/4 cup
Bread	2-11 gm per slice - check the label
Adzuki beans, cooked	17 gm per 8 oz
Kidney beans, cooked	15 gm per 8 oz
Nutritional yeast, flakes	4 gm per Heaping Tbs
Most Fruit	1 gm per Fruit
Vegetables	1-3 gm per 1/2 cup serving

Nuts and seeds and some fish are high in fat but these fats are easily used by the body for energy and the manufacture of other essential substances. The type of fat in natural food is higher in the omega 3 fatty acids which are used by the body to produce anti-inflammatory prostaglandins.

Can You Give Me the Potassium Content of Some Common Foods?

Whole foods such as vegetables, legumes and fruits are all good sources of potassium. Grains have very little potassium except in the bran. Lean meats trimmed of visible fat and poultry without the skin have about 1:1 calories : potassium. Wild game and most lean fish, fruits and vegetables have 1:2 calories:potassium.

All types of legumes are high in potassium as well as in protein; kidney, lentil, garbanzo, black or pinto being the highest. While some people with HypoKPP don't tolerate beans well on their own (they also contain carbohydrates), you can add beans to a meat-based chili or soup to increase both the potassium and protein content - and beans add color, flavor and texture.

A Preparation Tip:

Potassium in food is best retained by steaming, broiling or microwaving. When you boil food and discard the water you lose potassium, since it leaches into the water as the food cooks.

Fresh foods are best. If you must use canned foods buy low sodium or sodium free, water-packed. Frozen foods should be purchased with no added salt or sugar.

Potassium Content of Foods

Higher Range - 500 MG OR MORE
Medium Range - 300 - 499 MG
Lower Range - 100-299 MG

Sample menus

Breakfast: 1/2 cup 2% milk and one egg and fresh fruit or berries or other fresh fruit with 1/2 low fat cottage cheese, or for those who like cold cereal, 1/2 cup Raisin Bran fortified with 2 Tbs unsalted nuts (pecans, walnuts, almonds), 1 Tbs toasted wheat germ and 2 tsp unsweetened grated coconut.
Mid-morning snack - 1/2 cup Protein shake
Lunch: Salad with turkey or tuna 4 oz. and carrots, cucumber, sprouts, kidney or garbanzo beans, sweet red pepper, red cabbage, lettuce or mixed greens, onions and no-salt salad dressing of choice. Or 4 oz. fish or poultry or lean red meat and a cup of vegetable such as asparagus or broccoli and a fruit or one cup of mixed fresh fruit for dessert.
Mid-afternoon snack - 2-3 oz unsalted nuts
Dinner: Soup, stew or casserole with protein from poultry, fish, legumes or tofu and lots of vegetables, with an additional 3-4 oz serving of protein as above.
Evening snack - low salt cheese and 1/2 cup protein shake

RECIPES

Protein Smoothie

Protein Smoothies are easy, and made in your own kitchen they are far more economical than the mixes bought in the health food store. The mixes from The health food store are often high in sugar as well, which is not good for the Hypo diet. There are two versions to this recipe, the tofu/soy one and the dairy/milk one. Choose your preference. The method is the same.

One - 375 gram (12 oz) box of 'silken' (Japanese style) tofu (This is the one which is very smooth) Put it in the blender with 1 litre (1 qt) soy milk. (Alternately use 1 & 1/2 cups 2% cottage cheese and skim milk.)

Blend till smooth. Add 1 cup fresh or frozen (but not sweetened) berries (strawberries, blueberries etc.) or a fresh nectarine and peach cut into pieces, also a banana. Add 1 tsp vitamin c powder (to keep fruit from oxidizing) or crush up 2 1000 mg vitamin c tablets and add them. Add milk as you go to keep mixture liquid enough to blend. You should end up with 2 litres. You may also add 2 Tbs. safflower oil for essential omega fatty acids, and to even out the effect of the food hitting the system.

3/4 cup of a cup is a serving. This makes an excellent breakfast with a piece of fruit. A 1/2 cup serving can also be used as a mid-meal and bedtime snack.

Soy is great for this because it has a very low glycemic index. It provokes very little insulin release, so doesn't tend to cause episodes.

Indonesian Stir Fry

1 box silken tofu cut into cubes or 2 cups cubed chicken breast
Garlic clove crushed
2 cups mixed fresh vegetables in season cut for stir fry
Oil for frying
1/4 c unsalted old-fashioned peanut butter
2 TBS lime juice
2 TBS Plum sauce
Cayenne pepper sauce
2 cups cooked brown rice
1/2 cup roasted unsalted peanuts or cashews

Heat oil, adding garlic, Remove garlic. Cook chicken or tofu in oil, remove from oil, drain on paper and set aside. Stir fry vegetables until tender crisp. Place peanut butter, pepper sauce, lime juice and plum sauce in pan.

Adding water if necessary to make smooth sauce with consistency of thin gravy.

Serve vegetables and chicken over rice, with sauce and nuts on the side. serves four. (I go easy on the rice, taking only 1/4 cup)

Fruity Chicken Curry Salad

2 cups cooked chicken in bite-size pieces
1 cup firm tofu cubes cooked by any method
1 10 -ounce can unsweetened pineapple tidbits, drained
1/2 cup chopped celery
1/4 cup fat-free sour cream
2 tsps. good-quality curry powder
dash of cayenne pepper sauce, stirred into sour cream

Combine all. Serve over greens
Serves 4

Marinated Chicken Breasts

4 Tbs. fresh lime juice
1 tsp. Honey
1 tsp. minced fresh ginger root
1 tsp. minced garlic
1 tsp. chili sauce

In a flat pan or nonstick baking dish just large enough to hold the breasts in a single layer, combine the lime juice, soy sauce, honey, ginger, garlic and chili sauce. Place the chicken breasts in the marinade and refrigerate for at least 2 or up to 6 hours, turning occasionally. Preheat the oven to 350 F. Bake for 45 minutes. Makes 4 servings.

Periodic Paralysis News Desk

The Role of Diet in Hypokalemic Periodic Paralysis

High Potassium, High Protein, Low Carbohydrate Diet

The goal is to maintain a stable blood sugar

What are Carbohydrates and Where are They Found?

Carbohydrates are found in:

What is the Glycemic index?

Fiber slows digestion of carbs

Foods which score Greater than 100%

Glycemic Index Between 80 - 100%

Moderate Inducers of Insulin Production- Glycemic Index Between 50-80%

Reduced Inducers of Insulin Production-Glycemic Index Between 30-50%

Very Low Inducers of Insulin Production-Glycemic Index Less Than 30%

How Much Protein Do I Need?

Can You Give Me the Potassium Content of Some Common Foods?

A Preparation Tip:

Potassium Content of Foods

Higher Range:

Medium Range:

Lower Range:

Vegetables, Beans and Nuts

Higher Range:

Medium Range:

Lower Range:

Dairy Foods:

Higher Range:

Medium Range:

Lower Range:

Meat, Fish and Poultry:

Higher Range:

Medium Range:

Soy Products:

Sample menus

RECIPES

Protein Smoothie

Indonesian Stir Fry

Fruity Chicken Curry Salad

Marinated Chicken Breasts

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