You’ve been diagnosed with kidney disease, and there are probably a million things running through your mind. No doubt you’re feeling a little overwhelmed. Take a deep breath, and another one. I can tell you that it’s going to be okay, because you are in charge. Sure, like any change in life, new habits take time to develop. So take it one day at a time. Begin by preparing yourself mentally by meditating on the fact that your kidney disease can be controlled by how you manage your diet and lifestyle. Make a promise to yourself that you will try your best each and every day to change your dietary habits and lifestyle. Your personal commitment to yourself and your desire and motivation to follow through will have everything to do with how well you can manage your kidney disease. Remember, the earlier your kidney disease is detected, the sooner it can be treated. The goals of your treatment are twofold: to slow kidney disease and to prevent it from getting worse. That’s one unique thing about kidney disease: It will allow you to take control of managing it.
There is no one eating plan that is right for everyone with kidney disease. What you can or cannot eat will change over time, depending on your kidney function and other factors, like having diabetes, for example. By working closely with your health care providers and continuing to educate yourself, you can master the art of making healthy food choices to fit your needs and will be able to personally manage your disease with tremendous success.
The following are some basic dietary guidelines useful to all individuals with chronic kidney disease (CKD).
Protein can be found in foods from both animals and plants. Protein is a necessary macronutrient for a healthy body; however, for CKD patients, too much is not a good thing. As kidney function declines, the body loses the ability to remove waste produced by the breakdown of protein, so it starts to build up in the blood. The right amount of protein intake for you is dependent on your stage of kidney disease, nutritional status (such as albumin level and appetite), body size, and other factors. A registered dietitian can help you calculate your daily protein limits. As a guide, I’ve provided a list of lean sources of high-quality protein to choose from, with suggested serving sizes, in the table “High-Protein Foods.”
If you have kidney disease and smoke, your risk increases for end-stage renal disease. According to the Centers for Disease Control and Prevention, smoking harms nearly every organ of the body. Stopping may be the most important preventive measure you can take. Ask your doctor about nicotine-replacement options.
In a time of restriction, it may feel like good news to know that healthy fat in moderation is an important macronutrient to include on a daily basis. The consumption of healthy fats ensures you are getting essential fatty acids, which help the body in numerous ways. Monounsaturated and polyunsaturated fats are both unsaturated fats; they’re considered the healthiest of the fats due to their potential cardiovascular health benefits (including lowering total cholesterol, increasing HDL cholesterol, and decreasing LDL cholesterol). The right kinds of fats may also decrease inflammation in the body and protect your kidneys from further damage. Include small amounts of the following healthy fats in your diet.
MONOUNSATURATED FATS
(healthy fats, liquid at room temperature)
Avocados
Olive oil
Peanut oil
Sesame oil
Some safflower oil (high in oleic acid)
POLYUNSATURATED FATS
Corn oil
Fish, such as salmon, mackerel, herring, albacore tuna, and trout
Flaxseed or flax oil
Some safflower oil (high in linoleic acid)
Soybean oil
Sunflower seeds
Walnuts
Carbohydrates are an important macronutrient needed by the body. They are the body’s major source of fuel to provide energy. They also offer a wide range of vitamins, minerals, and fiber that help protect your body. Here are some renal-friendly sources of high-fiber carbohydrates to include in your diet on a daily basis, with suggested serving sizes, in the table “High-Fiber Foods.”
Too much sodium can make you thirsty, which can lead to swelling and increased blood pressure. High blood pressure can cause more damage to unhealthy kidneys. Eating less sodium helps lower blood pressure and may slow down CKD. The recommendation is for people with CKD to limit sodium intake to 2,000 milligrams per day. For best success in this area, remember “fresh is best.” Sodium is found abundantly in any food that has been processed, salted, cured, or pickled. Canned, frozen convenience, and fast foods tend to be very high in sodium. Conversely, the less processed a food is, the less sodium is added. If the “fresh is best” concept is a lifestyle change for you, be assured, this book has lots of delectable recipes that eliminate the salt and allow for discovery of other creative ways to season your food.
Did you know that your attitude influences how you feel? Make it a point to surround yourself with positive and supportive people and pursue activities that make you happy. A sunny outlook is proven to result in better health!
One of the best things that you can do to stay healthy is to limit how much sodium you eat. To do so, here are some “sodium swaps” you can try.
Potassium is found in many foods and beverages, and it plays an important role in regulating the heartbeat and keeping muscles functioning well. However, people with unhealthy kidneys often need to limit certain foods that can increase the potassium in the blood to a dangerous level. A potassium-restricted diet is typically about 2,000 milligrams per day. Your physician or dietitian can advise you as to the right potassium intake for you, based on blood work results and your individual health needs.
To reduce potassium buildup, you’ll need to learn which foods are high in potassium and which are low, so you know which to be careful with. Refer to the following “Potassium in Common Foods” table to learn which foods are high and low in potassium so you can make safe, low-potassium food choices.
Healthy kidneys help the body regulate phosphorus. However, with CKD, your kidneys are unable to remove excess phosphorus or excrete it. The end result is high phosphorus levels in the blood—this pulls calcium from the bones, which can lead to weak, brittle bones. Elevated levels of phosphorus and calcium in the blood can also lead to dangerous mineral deposits in the body’s soft tissues, an ailment called calciphylaxis. Phosphorus is found both naturally in animal and plant proteins, and more abundantly in highly processed foods. You can maintain safe levels of phosphorus in your body by making smart low-phosphorus food choices. The rule of thumb to prevent consuming unwanted hidden phosphorus circles back to the concept “fresh is best”; that is, avoid processed foods. Daily phosphorus intake for individuals with CKD should be 800 to 1,000 milligrams. Please refer to the following “Phosphorus in Common Foods” table to help you make wise low-phosphorus food choices.
Rather than just relying on supplements, following a balanced diet is the preferred way to get the recommended amount of daily vitamins. However, due to the restrictive nature of the CKD diet, it can be challenging to get all the necessary vitamins and nutrients you need on a daily basis. People with CKD have greater requirements for some water-soluble vitamins. Special renal vitamin supplements are also recommended to provide the necessary extra water-soluble vitamins. Renal vitamins contain vitamins B1 , B2 , B6 , and B12 , as well as folic acid, niacin, pantothenic acid, biotin, and a small dose of vitamin C.
One of the kidneys’ functions is to convert inactive vitamin D to active vitamin D so the body is able to use it. With CKD, the kidneys lose this ability. Your doctor may check your calcium, phosphorus, and PTH (parathyroid hormone) levels to determine if you need supplementation of active vitamin D, which is available by prescription only.
If your doctor has not prescribed a vitamin supplement, don’t hesitate to ask if you could benefit from taking one. For the benefit of your health, use only vitamin supplements approved by your kidney doctor or dietitian.
One of the main functions of the kidneys is to regulate fluid balance in the body. For most individuals with CKD, fluid restriction isn’t necessary as long as urine output is normal. As CKD progresses, there is a decline in urine output and an increase in fluid retention. When this occurs, fluid restrictions are necessary. Always pay close attention to the volume of your urine output, and tell your health care team if you find it is declining. They can best inform you on how much fluid to limit yourself to on a daily basis in order to maintain healthy fluid levels and help prevent fluid overload and medical complications associated with excess fluid buildup (such as edema, high blood pressure, congestive heart failure, and pulmonary edema).
Limit your daily protein intake to the amount calculated by your health care team. Choose lean, high-value protein sources.
Use heart-healthy fats (mono- and polyunsaturated) in moderation.
Choose high-fiber carbohydrates.
Limit sodium intake to 2,000 milligrams per day. Avoid highly processed foods that contain a lot of sodium. Try cooking with fresh, whole ingredients to create low-sodium meals.
Limit potassium intake to 2,000 milligrams per day.
Limit phosphorus to 800 to 1,000 milligrams per day.
Ask your physician about the benefits of a daily renal vitamin.
Fluid intake restrictions may not be necessary for CKD 1–4. Discuss your individual daily fluid needs with your health care team.
Working closely with your health care team is important to establish health-supportive personal dietary needs and goals. Many factors are considered when calculating an individual’s dietary needs: stage of renal disease, concurrent medical issues, lab results, and other variables. By learning as much as you can about your specific daily dietary needs, you can make smart, healthy food choices on your own that will reward you with good health. Use the following chart to log your dietary needs. From there, you can navigate this book and utilize all of its resources, from lists of foods to eat and not to eat, to shopping lists, daily meal plans, kidney-friendly recipes, and other helpful tools that will help you meet your personal daily nutrition needs and provide reassurance that you’re doing the best for your body. To calculate your nutrient needs, talk with your physician and/or dietitian. The number varies person to person depending on your height, weight, and laboratory values.
My Renal Diet
Daily caloric requirements vary from person to person, whether they have CKD or not. With CKD, eating enough calories and choosing the right foods can benefit your body more than ever before. Calories provide energy and help us function on a daily basis. They can also help prevent infection, avoid muscle-mass loss, maintain a healthy weight, and slow down the progression of kidney disease. However, if your caloric intake is too high, you will likely gain weight, which can put an additional burden on your kidneys. It is very important to get just the right number of calories. Caloric requirements for anyone with CKD are 30 to 35 calories per kilogram of body weight. For example, if you weigh 150 pounds, you need about 2,000 calories per day for optimal performance.
Many factors come into play when calculating how many calories you need on a daily basis. Your height, weight, age, gender, and the level of your physical activity are all considerations. That said, it is very easy to calculate your daily caloric needs. You can do it online with a tool created by the National Institute of Diabetes and Digestive and Kidney Diseases, and it takes only a few seconds. Visit www.supertracker.usda.gov/bwp/index.html for more information.
The renal diet takes some time to learn and put into practice. Luckily, all packaged food products come with a nutrition facts label and ingredients list. Reading these labels can be a real eye-opener! Let’s explore what to look for and how to decipher the information on the label, so you can make educated food choices to meet your personal nutrition needs. Reading labels can prove an essential tool for selecting renal-appropriate foods—a good habit to develop in general.
The most important ingredients that individuals with CKD need to look for on the food labels are fat, sodium, phosphorus, and potassium. By law, food manufacturers are required to list the fat and sodium content of a food. However, they are not required to list phosphorus or potassium content. Therefore, it’s important to obtain this information in other ways, such as from the lists in this book or the Internet.
Serving size: This information is provided in familiar units that consumers use (1 cup, 15 cookies, etc.).
Servings per container: This indicates how many servings of food are in the container. Note: All nutrient values listed are for one serving of food.
Calories: This is the number of calories in one serving of food.
Total fat: This is the total content of all fats—unhealthy and healthy—in one serving of food. Note: By law, food manufacturers are required to list only the unhealthy fat content in a food (saturated and trans fats), due to their role in the development of cardiovascular disease.
Look for foods that have 2 grams or less of saturated or trans saturated fats per serving.
Healthy fats—monounsaturated and polyunsaturated fats (which are not required to be listed but still may be in the food item)—should be consumed in moderation.
Choose foods that have less than 3 grams of total fat per serving, which is considered low-fat.
Some nutrient claims on labels can also be useful in selecting heart-healthy food items. Look for claims like “saturated fat-free,” “sodium-free,” “low saturated fat,” and “no trans fat.”
Sodium: As mentioned, the recommended daily intake of sodium is limited to about 2,000 milligrams. The Food and Drug Administration mandates that milligrams of sodium per serving must be listed for all food items. This takes the guesswork out of determining if that food item is renal-friendly or not.
Low-sodium foods: Look for those containing less than 140 milligrams per serving.
High-sodium foods: Avoid foods containing more than 500 milligrams per serving.
Nutrient claims on labels can also help guide your food selections. Look for “very low sodium,” “low sodium,” and “reduced salt.” Foods must meet certain requirements to use these claims.
Phosphorus: Most CKD patients are limited to between 800 and 1,000 milligrams of phosphorus per day (your specific needs can be determined by your health care team). Phosphorus content is not required by law to be listed on the nutrient facts label, but here’s a trick to get that information from the ingredients list. To determine if a food product has had phosphorus added, look for any ingredient that contains the four letters “phos.” Phosphorus is naturally occurring in animal and plant protein sources, so foods that have added phosphorus should be avoided completely. If phosphorus additives are on the ingredient list, do yourself a favor and put that food product back on the shelf.
Phosphorus additives include the following:
Phos
phoric acid
Sodium poly
phos
phate
Pyro
phos
phate
Sodium tripoly
phos
phate
Poly
phos
phate
Tricalcium
phos
phate
Hexameta
phos
phate
Trisodium
phos
phate
Dicalcium
phos
phate
Sodium
phos
phate
Monocalcium
phos
phate
Tetrasodium
phos
phate
Aluminum
phos
phate
Potassium: Most CKD patients are limited to about 2,000 milligrams of potassium per day (your specific needs can be determined by your health care team). Potassium is another nutrient that is not required by law to be listed on the nutrient facts label, but you can get some helpful information by reading the ingredients list. Potassium is naturally occurring in many fruits, vegetables, and dairy products, but it can also be added for flavor and as a preservative to many processed foods.
Want to learn more about the foods you eat (or want to eat)? The Environmental Working Group rates thousands of food products and provides nutritional information as well. Visit EWD.org/foodscores .
Steer clear of food items that have any potassium additives, such as the following:
Potassium acetates
Potassium alginate
Potassium alum
Potassium bisulfite
Potassium bromate
Potassium carbonate
Potassium caseinate
Potassium chloride
Potassium citrates
Potassium gluconate
Potassium hydroxide
Potassium nitrate
Potassium phosphates
Portion control is very important when you have kidney disease, but that doesn’t mean you have to go hungry. Whatever stage of CKD you’re in, eating in moderation is important to preserving kidney health, but the idea is not to feel deprived; rather, you can enjoy a variety of kidney-friendly foods without overeating. When you watch what you eat, and cut back on certain foods that can be harmful to your health, you are practicing portion control. Making a habit of eating in moderation and limiting certain foods on a kidney diet is yours to achieve—all it takes is a little time, some resolve, and an informed game plan.
Choosing the right foods on a renal diet is crucial to your kidneys; they’re counting on you to provide the right amount of nutrients to help them function at their best, including protein, carbohydrates, fats, vitamins, and minerals. Too much of any nutrient can be harmful to your body and require your kidneys to work extra hard to filter out the toxins.
One way to get used to portion control and choosing the right foods is by practicing the strategy of balancing your plate. Visualize your plate made up of ½ vegetables, ¼ protein, and ¼ carbohydrates, as pictured below.
I’ve packed a lot of information in these first two chapters, and it will take some time to remember it all. That’s okay; just take it one day at a time and stay committed to learning and achieving. By keeping this book on hand, you can return to these early chapters as often as necessary. Before long, you’ll be an expert on your body, knowing what it needs to thrive and sustain good kidney health.
