Eating Vegetarian Foods While Living With Kidney Disease
Historically, vegetarianism has been met with skepticism in chronic kidney disease (CKD) patients. However, we now know that with careful planning vegetarianism, or even part-time vegetarian eating is not only safe, but also beneficial to CKD management.1,2 Research shows eating vegetarian proteins can actually slow down the progression of kidney disease and other complications associated with this disease.1,2
Nutrition management focuses on decreasing waste product build up from digested foods, which would normally leave the body as urine. The primary goals of planning a diet with plant-based foods are three fold: 1.) obtaining the appropriate amount of plant protein to meet protein needs while minimizing waste product build up in the blood 2.) maintaining sodium, potassium and phosphorus balance and 3.) maintaining good nutrition. The following information is meant to be an initial guide to those with early kidney disease (30-50 percent of normal kidney function) and not receiving dialysis treatments. More careful follow up is recommended, especially when kidney function decreases below 30 percent or when regular dialysis treatment is required.
Sodium, Potassium, & Phosphorus
Sodium
Though vegetarian foods are healthy in general, some can be very high in sodium. A few foods to avoid for limiting sodium in plant-based foods include:8
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Convenience foods such as frozen meals, canned soup, dried soups, miso or packaged vegetable broths
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Soy-based cheese
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Processed dairy cheese
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Meat analogues — this includes such foods as tofu hot dogs, veggie burgers or other canned or frozen soy products
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Salt, soy sauce, tamari sauce or any spices that contain the words sodium or salt
Potassium
In general, potassium does not need to be restricted unless the function of the kidney decreases to less than 20 percent. Routine blood testing is the best way to know your potassium requirements. An estimated two-thirds of diet potassium comes from fruits, vegetables and juices. So initially, the easiest way to limit this mineral will be to minimize fruit and vegetable selections to five servings per day.
A potassium serving size:
1/2 cup fresh fruit, canned fruit or juice
1 cup fresh vegetables
1/2 cup cooked vegetables
If this does not decrease your serum potassium to the normal range, limit these foods:
High Potassium
Limit 1 per day
Textured vegetable protein 1/4 cup
Soy flour 1/4 cup
Nuts and Seeds 1/4 cup
Dried, cooked beans or lentils 1 cup
Dried cooked soybeans 1/2 cup
Tomato products 1/4 cup
Potatoes 1/2 cup
Dried fruit 1/4 cup
Tropical fruit 1/2 cup
Melons 1/2 cup
If you use a lot of beans or textured vegetable protein, alternative protein selections may be needed in order to keep potassium levels from going too high. This will mean using more tofu, tempeh, seitan and eggs or if you prefer some meat, fish or poultry to meet protein needs.
Phosphorus
Some plant proteins are high in phosphorous, but because of the high phytate content (a naturally occurring compound which blocks phosphorous absorption) these foods alone usually do not increase serum phosphorous levels.8 This includes dried cooked beans and nuts. Dairy products are the main source of concentrated phosphorus.14 This will mean decreasing dairy products to one serving or less per day. For the vegan a few other high phosphorus foods are worth noting:
High Phosphorus
Limit 1 per day
Milk 1 cup*
Cottage Cheese 2/3 cup
Cheese 2 ounces
Pudding or custard 8 ounces
Yogurt 8 ounces
Soy cheese 4 ounces
Soy yogurt
(non fortified) 12 ounces
*Non-dairy creamer, rice milk and up to two cups of soymilk per day can be used as a replacement for milk.
Good Nutrition
A plant-based diet is often lower in calories and higher in fiber than an animal-based diet. As a result, you need to be careful you do not lose weight. Here are some ideas to help add healthy calories to your eating plan:
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Soy shakes: Make shakes with soymilk, tofu, rice milk and non-dairy frozen dessert.
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Adding fats: Use more oils such as olive oil, peanut oil or canola oil in cooking. Drizzle flaxseed oil on food after it is cooked, or mixed with salad dressing over lettuce.
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Snacks: Eat small frequent meals if you fill up quickly.
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Sweets: Even though a high sugar diet is not the best choice for food, on occasion these calories can be beneficial to avoid weight loss. Good choices are jellybeans, hard candy, sherbets or sorbet.
Vitamins and Minerals
Supplementation of vitamins and minerals in kidney disease needs to be treated on an individual basis. Most people will require a water-soluble vitamin without fat-soluble vitamins or minerals. Mineral levels will need to be checked individually to determine if a supplement is needed. High dosages of any vitamin and or mineral in kidney disease are discouraged since the poor clearance from you kidney can cause toxic levels in the blood.15
Where To Turn For Further Help
It is best to be guided by a nephrologist and a registered dietitian that is familiar with vegetarianism for the optimum nutrition planning. Together these professionals can help manage kidney disease while assisting in appropriate vegetarian food selections. The following organizations can help in locating a dietitian who works with vegetarians: