Hypokalaemic Periodic Paralysis
Carbohydrate triggers in HypoPP
There are a number of patients with periodic paralysis who experience attacks of weakness following a meal with carbohydrates. This may be a meal eaten late in the evening which leads to an attack of weakness in the early hours of the morning. Attacks of weakness can also happen during the day after meals with high carbohydrate content.
The patients who experience attacks are ones who are sensitive to low potassium levels. Certain carbohydrates cause a surge in insulin. Insulin is the hormone that helps to change the carbohydrate in food to a usable form in the blood, with any glucose (sugar) that is spare being stored for later use. This surge in insulin can cause a drop in the potassium level in the blood. This potassium drop affects the ion channels, causing weakness of the muscles. This weakness is experienced as an episode of paralysis.
What sorts of carbohydrates are best to avoid triggering attacks?
It is useful to know which carbohydrates are your main triggers. Maintaining a food diary for a couple of weeks will help to identify these.
We advise patients to try and eat slow-acting (low glycaemic index - GI) carbohydrates as these take longer to break down and are less likely to cause a drop in potassium levels.
Foods that are high carbohydrates are:
Baguette, bagels, bread stuffing, cereals (Coco pops, corn pops, Crunchy Nut Cornflakes), dark rye bread, gluten-free bread/maize pasta/rice, white rice, Shredded Wheat, Sultana Bran, white bread, wholemeal bread, broad beans, jacket potatoes, mashed potato, parsnips, pumpkin, swede, dates, watermelon, doughnuts, French fries including frozen, fruit bars, honey, popcorn, rice cakes.
Examples of low GI carbohydrates are:
All-Bran, barley, buckwheat, bulgur wheat,
oat bran, oats, seeded breads, sourdough rye, soya and linseed bread, toasted muesli
baked beans, black eye beans, butter beans, chickpeas, kidney beans, lentils, small new potatoes boiled in skins, peas, soya beans
Fruits with a low GI include:
Grapefruit and its juice, grapes, Kiwi fruit, mangoes, oranges
peaches, pears, plums, prunes, strawberries, apples and bananas
Adjusting what and when you eat can have a noticeable effect on the frequency and duration of your attacks of paralysis.
Once you have kept your food diary for a couple of weeks, arrange a telephone review with the specialist nurse who will be able to discuss with you, where any adjustments can be made to help with your attacks.
