Chapter 1

Being told that you have chronic kidney disease (CKD) doesn’t have to mean you should stop going out and socialising, eating food you like, exploring different tastes and sharing in special occasions. By taking a few sensible precautions, you can continue to enjoy your chosen lifestyle to a much greater degree than you may have feared.

The amount of attention you pay to your diet when you are not at home really depends on how often you eat out. An occasional meal is unlikely to make much difference to your overall diet. But if you eat out at least once a week, you may need to choose your menu with a bit more care. Just as at home, your choices will depend on your own particular tastes, medical condition, blood results and lifestyle.

The main exception to this is if you need to follow a low-potassium diet. You will always need to be ‘potassium aware’ whether it is a one-off meal, or a regular event. This is because even short-term rises in potassium levels in the body can be harmful.

Unless your doctor has advised you otherwise, it is fine to include alcohol with meals and other social occasions, but drink it in moderation. Alcoholic drinks are quite high in calories, and some types also contain a fair amount of potassium. Alcohol can also interfere with control of diabetes if you have it. Therefore, remember to ask for information about alcohol when you are seeing your doctor or dietitian. It can also weaken your efforts to resist tempting extras – would you really have that extra bag of crisps or the greasy takeaway if you were stone-cold sober?

It will really help to keep well away from salty nibbles and snacks, such as crisps, nuts, Bombay mix, pastries, samosas, fried fish cakes, potato shapes etc. These are often high in fat and calories and it’s hard to keep track of exactly what you have eaten. They may also make you thirsty and cause you to drink more sugary or alcoholic drinks. But for many of us, the worst thing about nibbles is that once you start you can’t stop!

•Tip: Try a longer drink! Add a sugar-free or low-calorie mixer to your alcohol to make it go further:

•Shandy – sugar-free lemonade with lager

•Spritzer – sparkling water with white or rosé wine

•Gin and slimline tonic

•Vodka with low-sugar cranberry juice

Preparing yourself and the people who are cooking for you can make all the difference. For example:

•If you are going to a restaurant, try to contact the manager in advance. Ask about the choice of food, and discuss any special arrangements that might be needed.

•If you have been invited to someone else’s home, you will make meal planning much easier for your hosts if you phone ahead to discuss what you can and can’t eat.

•If you know that you might be eating a less suitable food for dinner at a friend’s house, you might just decide that you will be more careful during the day to compensate. For example, you could avoid that tempting sausage sandwich for breakfast to allow for the extra calories/fat/salt later on.

•A few simple changes to the way food is prepared and served can make a meal much easier for you to eat. Butter, sauces, gravy and salad dressings can be served separately or left out altogether; a high-potassium vegetable or fruit may be changed for a low-potassium alternative; garnishes can be omitted.

Our multicultural society offers a wealth of eating experiences both at home and when eating out. Talking to your health adviser about the sort of diet you and your family like to eat can be very helpful. They may be unfamiliar with your particular diet, but are likely to be keen to learn from you. If you see a dietitian, he or she will work together with you to ensure that any dietary changes don’t have to stop you from eating your traditional or family foods.

DOs and DON’Ts for eating out

DO try to plan ahead – you may be able to adjust your diet before or after the meal out to allow for any foods and drinks that you would not normally have.

DO consider how often you eat out when deciding how flexible to be with your diet.

DO try to choose suitable foods when you are out. If you run into difficulties choose only a small amount of the unfamiliar food.

DO remember to allow for alcoholic or non-alcoholic drinks as part of any social occasion or a meal out, especially if you are on a reduced-calorie, low-potassium or fluid-restricted diet.

DO ask your host or waiter to serve the food appropriately. For example, many sauces, dressings, garnishes and other extras can often be served separately or left out altogether.

DON’T be afraid to ask the restaurant, café or takeaway to change a dish to suit your requirements. It’s often worth telephoning ahead to check that they will have something that you are happy to eat.

DON’T forget to ask your dietitian for advice on eating meals out and at special occasions. Dietitians will be happy to provide information (both for you and for your relatives and friends) that is geared to your own particular diet and needs.

Here are a few general tips to consider when choosing some of your favourite meals.

•Food from China and the Far East can be very salty. Avoid adding salt or salty sauces such as soy sauce or fish sauce. Ask for food without added MSG (monosodium glutamate), another source of sodium. Reduced-salt soy sauce is available but still needs to be used sparingly.

•Plain boiled or steamed rice or noodles are suitable accompaniments to any meal. Fried noodles and rice are higher in fat and energy but if you include them try to make sure they are cooked in a ‘healthy oil’ such as sunflower, soya or rapeseed oils (see Chapter 10).

•Many typical flavourings (ginger, garlic, allspice, lemongrass) can be enjoyed freely for a delicious taste on a low-salt diet.

•If you choose a dish which comes with plenty of sauce, such as a Thai curry, try to leave much of the sauce behind in the serving dish. This will cut down on the amount of salt and fat (and potassium) that you eat.

•Stir-fries can be a convenient option to retain more of the taste and nutrients in your meal – especially if cooked at home with a minimal amount of fat. They are a good way to include plenty of vegetables in your meal. If you are on a low-potassium diet, count them within your vegetable allowance or as advised.

•As a starchy carbohydrate, pasta is a good basis to a meal and its low glycaemic index will keep you fuller for longer. Avoid those rich creamy or cheesy sauces – add plenty of vegetables instead.

•Olive oil is a monounsaturated fat and an essential part of the ‘Mediterranean’ healthy approach to eating. However, it is just as high in calories as any other fat.

•A low-salt dressing for fish, meat and vegetables can be made from balsamic vinegar or lemon juice, olive oil and black pepper. You can limit the oil or leave it out altogether if you are trying to lose weight.

•Bread is tasty and convenient; Italy and other Mediterranean countries have a wide range of breads to choose from. Try ciabatta, pitta bread or breadsticks as an accompaniment or starter. However, watch out for the saltier breads, such as foccacia and those with added ingredients such as olives or even salt crystals.

•Wherever possible avoid adding extra parmesan or other hard cheeses to dishes, as they are high in salt and saturated fat. Soft cheeses such as ricotta, mascarpone and cream cheese are lower in salt and you should be able to find low-fat versions or alternatives to use at home.

•Pizza is another favourite, but often salty and high in fat with all that cheese on top. Avoid ‘stuffed-crust’ or similar American-style pizzas and salty ingredients such as anchovies, olives, cured meats. Ask for less cheese and extra vegetables instead. Try our recipe for homemade pizza or add your own (healthy) toppings to a bought base for a quick meal at home.

•Use the minimum of oil to prepare curries and other dishes at home. Trim all fat from meat and remove skin from poultry before using. You do not want to be able to see a layer of oil on the finished dish.

•When eating out, try to leave some of the sauce in the serving dish and just eat the meat, fish or vegetables – this will cut down on the salt and fat you eat. You can achieve the same effect at home by serving food with a slotted spoon.

•Try to avoid choosing dishes made with fattier ingredients such as creamed coconut or cream. At home replace with lower-fat alternatives such as reduced-fat coconut milk, yoghurt or fromage frais.

•Boiled rice is a good accompaniment to your meal. At home cook without adding salt but you can try adding lemon rind, cinnamon stick, cloves, turmeric or saffron to the cooking water for extra flavour.

•When cooking at home, keep to unsaturated ‘healthy’ oils such as rapeseed (often sold as ‘vegetable’ oil), corn, sunflower oils instead of butter or ghee. Still use as little as possible if you are watching your weight as all oils and fats are high in calories.

•Avoid deep-fried snacks and starters. Try baked or grilled snacks instead. Uncooked popadum disks can be cooked in the microwave instead of frying.

•There is a great choice of fruit and vegetables to sample. If you are on a potassium restriction your dietitian can help you include them safely.

•Keep your salt intake down by avoiding salty pickles, chutneys and ready made ‘curry’ sauces – try using more naturally low-salt flavours such as fresh herbs, fresh and dried chillis, garlic, ginger, lemon, limes and traditional spices.

•Stews and ‘soups’ are a traditional way to serve meat or fish with vegetables in one dish. Using a slotted spoon to dish up a portion of stew allows the liquid to drain away and reduces the fat, salt (and potassium) content of the meal.

•A wide range of starchy staples such as plain rotis, rice, ground rice, and couscous make a healthy basis to any meal. Sweet potato and especially yams and cassava are low GI choices. If you are on a low-potassium diet, try to boil vegetables, potatoes and other starchy staples, before eating or adding them to stews and similar dishes.

•To cut down on your sodium (salt) intake, try to avoid dishes containing salted meats and fish. Fresh meat and fish are good alternatives. Trim away meat fat and remove poultry skin before using. If you are preparing salted meat or fish at home, soak and rinse thoroughly in plenty of water to wash away some of the salt.

•A wide range of flavourings can be enjoyed including fresh and dried thyme, coriander and other herbs, garlic, chilli, allspice and other spices.

•Limit nuts, including coconut and peanuts, if you are on a low-calorie, low-phosphate or low-potassium diet. Choose reduced-fat coconut milk instead of the standard version.

Family, national and religious holidays and celebrations can have a great influence on how we eat. From birthdays and bank holidays, to Chanukah, Eid and Diwali, many occasions have special foods and meals associated with them. Christmas, in particular, is associated with a vast range of seasonal foods that are available for several weeks of the year and will probably affect your diet whether or not Christmas is part of your own family traditions.

•Roast meats such as turkey, pork, beef or lamb are a good choice eaten hot or cold. Instead of using salt, try cooking with lemon, garlic, black pepper, spices or fresh herbs such as rosemary to add flavour.

•Gravy and bottled sauces can be very high in salt and/ or fat. Fortunately cranberry sauce, mint sauce, and homemade mustard (make up the powder with water or vinegar) are popular exceptions to this rule. A big portion of vegetables will keep things moist and tasty without adding lots of gravy.

•Many special occasion foods tend to be high in potassium, especially around Christmas time. These include some of the vegetables such as parsnips, roast potatoes, yams and Brussels sprouts as well as dried fruit, crisps, nuts, chocolates, Indian sweetmeats and fried snacks, fruit juices and fortified wines. If you are on a potassium restriction, you will need to eat them sparingly to keep your potassium levels under control. Ask your dietitian for advice on enjoying seasonal foods without harming your health.

•Many savoury nibbles, such as crisps, pakora, nuts and Bombay mix are high in salt. Try lower salt alternatives such as unsalted crackers, crisps, tortilla chips, fried/baked vegetable or apple crisps. Have a few walnuts, pecans (buy them unshelled and you tend to eat less) and roasted chestnuts, or try fresh fruit.

•Both sweet and savoury nibbles can be very high in fat and calories – and once you start it’s difficult to stop! Try to avoid them or decide on a limit, especially around Christmas or other festive periods where they are constantly available.

•Dried fruit (figs, currants, dates, prunes etc.) are a high-fibre, low-fat sweet treat if you do not need to restrict your potassium intake. Other special occasion fruit – such as pineapple, strawberries, melon, cherries and grapes – can make healthy sweet desserts and snacks. Raw vegetables (carrots, red pepper, cauliflower etc.) are good for dipping – try low-fat salsas or yoghurt dips, homemade houmous or vegetable dips instead of the creamy or cheesy kind (see recipe section).