Food for thought: Kidney Friendly Nutritioncentraleastlhin.on.ca/.../Kidney_Friendly_Nutrition.pdfA kidney friendly diet will reduce your daily intake of phosphorous to less than 1000

April 2009 Regional Nephrology System 1

Regional Nephrology System

Food for thought:

Kidney Friendly Nutrition

Prepared by the Dietitians of the Regional Nephrology System March 2009


What’s Inside….. Section Content Page(s)

One General Information • Why should I follow a kidney friendly diet? • Why should I see a Dietitian? • How to contact my Dietitian. • The kidney friendly diet.

5-10 6 6 7 8-9

Two Phosphorous • Targets and intro. • What is a lower phosphorous diet? • Food additives, what you need to know. • Phosphate binders. • High phosphorous foods. • Low phosphorous foods. • Milk substitutes.

11-26 12-13 14-15 16-17 18-19 21-22 23-24 25-26

Three Sodium (Salt) • Targets and intro. • High sodium food list. • Spice it up your diet: tips for adding flavour. • Salt substitutes and seasoning recipes. • Soups and your kidney friendly diet.

27-38 28-30 31-32 33-35 36 37-38

Four

Protein • Targets and intro. • Protein and your kidneys. • How much protein do I need?

39-44 40 41 42-43

Five Potassium • Targets and intro. • Potassium and kidney friendly diet. • Reducing potassium in potatoes. • Low potassium pasta sauces. • Potassium food lists-fruits. • Potassium food list- vegetables.

45-60 46 47-48 49-55 56-57 58-59 60

Six

Fluids • Targets and intro. • Should I limit my fluid intake? • Caffeine. • Alcohol. • Nutritional Milkshakes/Supplements.

61-65 62 63 63-64 64-65 65


What’s Inside….. Section Content Page(s)

Seven

Diabetes • Targets and intro.

67-68 68

Seven

Cholesterol and your kidneys • Target and Intro. • Fibre food choices that are kidney friendly. • Omega -3 fats.

69-74 70-71 72 73-74

Eight

What’s for dinner? • Eating kidney friendly in restaurants. • Kidney friendly choices at Donut shops. • Kidney friendly snacks.

75-80 76-78 79 80

Nine

Shopping • Reading food labels. • Grocery shopping suggestions.

81-90 82-86 87-89

Ten

Other Resources • Cookbooks for kidney patients. • Resources on the internet. • Measurement chart.

91-96 92-93 94 95

Eleven

Exercise • Targets and Intro.

97-98 98

Twelve

References 99-100



General Information


Why should I follow a kidney friendly diet? Your nutrition plays an important role in the treatment of Kidney Disease.

Your kidneys can best be described as filters and a healthy kidney will work

to remove waste products from your blood. Waste in the blood is produced

from excess minerals and water from the foods and fluids we eat and drink

and the breakdown of food to provide energy and to build tissues like

muscle and bone. When kidney function decreases, waste products are not

removed and begin to build up in the blood. The build-up of some wastes

can cause complications; therefore what you eat can help prevent those

complications.

Why should I see a Dietitian? Nutrition is a key part of your kidney care and your Dietitian is an important

member of your health care team. Kidney disease is progressive, meaning

there is no cure and as time goes on your kidney function will continue to

decrease. A kidney friendly diet can help you feel better and reduce the

chances of you developing other health problems. Following the

recommendations from your health care team, including eating a healthy

diet, can also help slow the progression of kidney disease.

The kidney diet can be confusing. Your Dietitian will help you determine

the best diet for you. Please let your Dietitian know if you are receiving diet

information from other health professionals to ensure that

recommendations are appropriate for you.


As your kidney function changes your diet may need to also change. Your

Dietitian will monitor your kidney function and offer suggestions to you on

how to change your diet. Your Dietitian will review your blood work each

time it is done. You can expect to meet with the Dietitian at least twice per

year and the Dietitian is always available to meet with you and your family.

There are several Dietitians working within the Nephrology program.

How do I contact my Dietitian? You can contact the Dietitians at 905-576-8711 ext 6968.


The Kidney Friendly Diet: There is a diet for chronic kidney disease and not all kidney patients will

follow the same diet. A kidney friendly diet is individually planned and

based upon your current results from blood tests. Your diet

recommendations are developed with you, based on how well your kidneys

are working, your likes and dislikes, your nutritional needs, and your blood

work.

Components of a kidney friendly diet: A kidney friendly diet may have recommendations about the following;

Minerals

Vitamins

Protein

Calories

Minerals

Phosphorus, sodium and potassium are minerals that have several

important roles in your body. They come from the foods that you eat and

the fluids that you drink.

Vitamins

Vitamins are compounds found in food. They are needed to keep the body

healthy. Some vitamins need a healthy kidney to work. Depending on your

kidney diet you may not get enough vitamins. Speak with your Dietitian or

pharmacist about taking an over the counter vitamin supplement.


Protein

Your body requires a certain amount of protein every day to stay healthy

and to fight infection. Dietary protein is found in almost all foods but is

highest in foods that come from animals. Eating too little protein can cause

poor health. If you eat too much protein, you will be placing added stress

on your kidneys and may further damage them. A kidney friendly diet is not

restricted or low in protein, but is planned to provide you with enough

protein for your health and current stage of kidney disease and treatment.

Calories(Energy)

Calories are the energy found in food. All food contains calories. It is

important that you eat a diet balanced in calories. Too many calories will

result in weight gain. Being overweight can affect your kidney function. It

is also important to note that too little calories will result in weight loss and

this will also affect your kidney function and overall health.

Each person with kidney disease has different nutritional needs. There is no benefit to restricting your diet more than you need to.

Speak with your Dietitian if you have questions about your kidney diet.



Phosphorus


Phosphorous

Follow a reduced phosphorous diet and protect your; • Bones

• Heart and lungs

• Arteries and veins

How is it measured? • Phosphorous is monitored by a blood test.

Phosphorous levels in blood: Target for pre-dialysis is 0.87-1.49.

Target for patients on dialysis is less than 1.78.

Calcium-phosphorous product: If you multiply your phosphorus result by your calcium result it

should be less than 4.4.


Phosphorous Phosphorous is a mineral found in many of the foods we eat. It plays an

important role in bone health and helps with the function of your nerves and

muscles. A healthy kidney will keep phosphorous levels in the blood within

normal limits by removing excess phosphorous through the urine. As

kidney function decreases, it becomes more difficult for the kidneys to keep

phosphorous levels in the blood within the recommended range.

Avoiding high phosphorous foods can help prevent a build-up of

phosphorous in your body. This will help to protect your bones, heart and

lungs. When phosphorous levels in the blood are high, calcium will move

out of your bones, leaving the bones weak, brittle and painful. If

phosphorous and calcium levels are too high in the blood, the phosphorous

and calcium join and form calcium-phosphorous crystals. These crystals

can settle in arteries and veins, blocking blood flow, or settle in organs such

as your heart and lungs affecting their function. High levels of phosphorous

in your blood can also cause your skin to become very itchy.

A kidney friendly diet will reduce your daily intake of phosphorous to less

than 1000 mg per day. This provides the body with enough phosphorous to

maintain health, but will help to prevent a build-up. Each clinic visit your

phosphorous level will be checked and your calcium/phosphorous product

will be calculated. Calcium/phosphorous product is a way your healthcare

team can determine your chances of having calcium/phosphorous crystals

form in your blood.


What is a lower phosphorous diet? Choosing the right foods can help keep your phosphorous level under

control and prevent complications. Here are some helpful guidelines. A

more detailed list of high and low phosphorous foods can be found on

pages 21-24.

Choose white or rye bread, 60% whole wheat or cracked wheat instead

of 100% whole wheat or multigrain.

Choose low fibre cereals such as Special K®, Rice Krispies® or cream of

wheat instead of bran, granola or oatmeal. (Phosphorous is found in the

bran part of the grain.)

Enjoy homemade waffles, pancakes, cakes, muffins and tea biscuits but

avoid ready made, frozen or mixes.

Choose soft drinks/pops that do not contain phosphorous some

examples are non-cola pops such as gingerale, Sprite®, orange soda,

cream soda or 7-up® . Read the labels (see page 80-84) to make sure

that they do not contain phosphorous. Avoid cola pops such as Coca-

Cola®, Diet Coke®, Pepsi®, and Diet Pepsi® or any other cola products

as these always contain phosphorous.

• Reduce your intake of milk products to 8 oz (250 ml) per day. Milk

products include the milk you drink, cream or milk in coffee or tea as well

as foods made from milk such as yogurt, ice cream or pudding.


• Avoid eating large amounts of dried beans or peas eg: pinto, lima, navy,

lentil, kidney, blackeyed peas, split peas, white beans, garbanzo

beans/chickpeas, pea soup, baked beans, hummus.

• Avoid foods that contain chocolate such as chocolate bars, puddings,

cookies, muffins, cake, hot chocolate and candies. Chocolate is high in

phosphorous.

• Avoid foods that contain nuts, peanut butter, almond butter or seeds.

• Avoid organ meats such as liver or kidney.

• Remove the bones from fish (salmon) and avoid fish that contain edible

bones such as sardines, herring and kippers.

• Avoid ultra low fat food items as phosphorous is often used to replace

fat.

• Avoid instant pudding mixes.

• Avoid hot beverages that contain added phosphorous such as hot

chocolate, mochaccino, Postum®, Ovalitine®, Melo®, Horlicks®, Caflib®.

• Avoid caramel candies.


• Snack foods avoid: nuts, nut butters, seeds, cheese flavoured popcorn,

caramel popcorn, and whole wheat pretzels.

• Side items avoid white sauces and cheese sauces unless you count

them as part of your dairy milk allowance and weekly cheese allowance.

Baking powder contains phosphorous. Its chemical name is

sodium triphosphate. Grocery store baked goods and baking

mixes (cake, cookies, pudding and biscuits) contain large

amounts of sodium triphosphate. You can lower the phosphorous in

favourite homemade baked goods by substituting regular baking powder

with the following:

½ tsp cream of tartar + ¼ tsp baking soda = 1 tsp regular baking powder

Food Additives….. What you need to know?

The Canadian diet is higher in phosphorous than ever before.

Phosphorous is now being used as an additive to help enhance the quality

and flavour of food. Processed meats (flavoured chicken breasts, ready to

serve entrees such as roast beef, chicken nuggets, hot dogs, and luncheon

meats); processed and spreadable cheeses, instant puddings, sauces and

marinades, refrigerated bakery products and some beverages contain

phosphorous based additives.

The type of phosphorous used in these products is not the same as the

phosphorous found naturally in food. This type of phosphorous is much

easier for your body to absorb and enter the blood than the natural


phosphorous found in milk and unprocessed meats. A good rule to follow:

if a food has had some of the preparation done for you or needs little or no

preparation- check the label. It most likely contains phosphorous additives!

Be Aware…become a label reader The phosphorous level of a food may not be listed on the food label.

Checking the list of ingredients can help identify if a food contains added

phosphorous. Ingredients containing words “phosphoric” or “phosphate”

such as phosphoric acid or ammonium phosphate can be indicators that

the food is high in phosphorous. Examples of some additives that contain

phosphate include;

Phosphoric Acid Sodium Polyphosphate Pyrophosphate Sodium Tripolyphosphate Polyphosphate Tricalcium Phosphate Hexametaphosphate Trisodium Phosphate Dicalcium Phosphate Sodium Phosphate Monocalcium Phosphate Tetrasodium Phosphate Aluminum Phosphate

Avoid meats with added sodium. Also check labels of fresh and frozen meat products. If the product has

more than 95 mg of sodium per 85 gram serving it means it is also high in

phosphorous. Meats that have added phosphorous will often have terms

such as “seasoned, flavoured, and tenderized”. Meats that are self-

basting are also high in phosphorous.


Phosphorous Binders (also called phosphate binders) The best way to keep phosphorous in the blood at the recommended level

is to follow a low phosphate diet. If levels remain high, despite limiting high

phosphate foods, your health care team may suggest you take a

“phosphate binder” (eg. Tums® or calcium carbonate, Renagel®,

Fosrenol®). Phosphate binders act like sponges or magnets. And will soak

up the phosphorous from the foods you eat. This will then allow the

phosphate to pass out of your body when you have a bowel movement. For

binders to work it is important that you take them in the recommended

amounts and at the recommended times.

Some Phosphate Binder Tips 1. Take the number of binders your healthcare team recommends. Your

Dietitian can help make sure that the number of binders you take with

each meal and snack is appropriate for the amount of phosphorous you

usually have at that time of the day.

2. Phosphate binders should be taken with your meals.

3. If you find the calcium tablets hard to swallow, your can break them in

smaller pieces or grind them and mix with soft foods (e.g. applesauce). If

you take Renagel® or Phoslo® tablets, they must be swallowed whole.

4. Do not take binders on an empty stomach unless you are told to do so

by your healthcare team.


5. Iron supplements should be taken at least 2 hours before or after you

take Calcium carbonate/TUMS®/ Phoslo®/Fosrenol®.

6. Calcium binders should not be taken with antibiotics. If you are

prescribed an antibiotic at the same time as your binders, discuss this

with your health care team.

7.

My binder prescription is:

BREAKFAST LUNCH DINNER SNACK TYPE OF BINDER

NUMBER OF BINDERS

Adapted from GTA working group “What is phosphorous and why do I need to limit it?”

by the Dietitians of the Regional Nephrology System 2006.



High Phosphorous Foods

The following foods contain large amounts of phosphorous. It is

recommended that you avoid these foods whenever possible to reduce the

amount of phosphorous in your diet.

Milk and milk products: Avoid • buttermilk, chocolate, goats, and malted milk • all instant, chocolate, and coconut puddings and yogurt beverages • ice cream containing nuts or chocolate • blue, goats, gruyere, tilset, swiss and processed cheeses. Grain products: Avoid: • breads, buns, pitas, crackers, pasta, or cereals made from whole grain,

12 grain, multigrain, 100% whole grain, dark pumpernickel, dark rye, ancient grain breads

• bread, cereals, crackers, buns, or other dishes made from corn meal • bran cereals (bran flakes, all bran), or multigrain cereals (red river cereal

or instant cereals (oatmeal, or cream of wheat) • foods that contain coconut, nuts, nut butters seeds or chocolate • frozen pancakes, waffles • pancake, waffle, tea biscuit mixes • granola based cereals and bars • brown rice • buckwheat and whole wheat pasta • cakes, muffins or other bakery products that are commercially made or

made from a mix • commercially baked products like cakes, muffins, scones Limit: • cereals like Shreddies®, quick cook oats, Quaker Corn Bran® to 2-3 times

per week

Fruits: • all fruits are low in phosphorous and are all ALLOWED (if you are

following a reduced potassium diet, see the low potassium sheets in the potassium section)


High Phosphorous Foods continued……..

Vegetables: Avoid: • legumes: navy beans, split peas, lentils, lima beans, black eye peas,

broad beans, chick peas, kidney beans, soya beans Limit: • broccoli, corn, green peas, mushrooms Fats: Avoid: • salad dressings that contain milk, yogurt or cheese Beverages: Avoid: • beer, hot chocolate, flavoured milk beverages (Rolo®, Coffee Crisp®, Kit

Kat®, Crispy Crunch®) or malted milk beverages (Ovaltine®, Postum®, Milo®, Horlick®, Caflib®) colas (Coca-Cola®, Pepsi, Dr. Pepper®,Cool®), ice tea/drinks, Sunny Delight®, tropical Punch (Hawaiian Punch®), weight-loss beverages (Slim Fast®), flavoured water

Processed meats and meat products Avoid: • processed, smoked, marinated, flavoured or cured meats, liverwurst or

pate • foods that contain fermented soya such as miso soup • organ meats (liver, kidney etc.) • nuts and nut butters (peanut butter, almond butter) • fish in which you eat the bones (sardines, anchovies). Remove edible

bones from salmon • oysters, clams, mussels, caviar, and fish roe

Other Avoid • macaroni and cheese dinners


Low phosphorous food list Here are some examples of low phosphorous foods; your Dietitian can help

you with choose kidney friendly food.

Milk and milk products Limit to a total of 8 oz (250 ml) per day: • milk 2% & 1% or skim, coffee cream, whip cream, sour cream, yogurt,

homemade puddings, ice cream (no nuts, not chocolate) Limit hard cheese to 3 oz per week • cheddar, mozzarella, marble, parmesan, romano, harvarti, colby, dry curd

cottage cheese, monterey, bocconcini, brie Grain products Choose • white bread,/buns, light rye, 60% whole wheat breads, cracker wheat bread,

brioche, challah, egg bread, english muffins, matzon, crumpets • Corn Flakes®, puffed rice, cream of wheat, cream of rice , Special K®,

Crispix®, Just Right®, puffed wheat®, Rice Krispies®, Rice Chex®, rice flakes, Alphabets®, Applejacks®, Captain Crunch®, Froot Loops®, Frosted Flakes®, Vanilla Rice Krispies®

• white rice, white pasta • homemade pancakes and waffles • homemade cakes, muffins or tea biscuits • graham crackers, matzo (plain or egg and onion), melba toast (plain), soda

crackers (unsalted) • animal crackers, arrowroots, butter cookies, sugar wafers, short breads,

social teas, sugar cookies Limit to 2-3 times per week: • cereals like Shreddies®, quick cook oats, quaker corn bran


Low phosphorous food list continued…….. Fruits: • All fruits are low in phosphorous and are all ALLOWED (if you are following

a low potassium diet, see the reduced potassium sheets in the potassium section)

Vegetables: Choose • Carrots, green and yellow beans, lettuce, peppers, radishes, celery,

cabbage, onions, green onion, tomatoes, spinach, squash, beets, cauliflower, potatoes, sweet potatoes, turnip, zucchini

Limit: • broccoli, corn, green peas, mushrooms. (if you are following a reduced potassium diet, see the low potassium sheets in the potassium section) Fats: Choose • butter, margarine, mayonnaise, vegetable oils Protein, Meats and Meat products Choose • fish (cod, haddock, salmon* bones removed, snapper, trout) • unseasoned beef, pork or poultry • shrimp, lobster, crab, scallops • egg whites • tofu

* look for low sodium versions


Milk Substitutes: Limiting your intake of milk products to 8 oz (250ml) per day will help

reduce your total intake of potassium and phosphorous. Milk substitutes

are products you can use instead of milk that are low in phosphorous and

potassium. These products do contain calories. Discuss with your Dietitian

how much of these products you can use.

Rice Dream® (original)

• Located in the “coffee” aisle.

• Choose the original or vanilla flavoured.

• Do not use the enriched products.

• Do not use Soy Dream®.

Dairy Free®:

• Can be hard to find – try the “health food” section at the grocery store

• Look for it at ;

• Real Canadian Superstore or Loblaw’s.

Go Natural Health and Nutrition,

121 Brock St. N. Whtiby (905) 668-2661

122 Simcoe St. N (905) 436-2661

www.gonaturalcanada.com


Coffee Rich®:

• Located in the frozen food section of the grocery store.

If you like or need: Then use this: heavy cream half and half sweetened condensed milk

Coffee Rich®

1 cup of butter milk Mix 1 cup of Coffee Rich® with 1 tbsp of white vinegar

1 cup of whole milk Mix ½ cup Coffee Rich® and ½ cup of water

1 cup skim milk 4 tablespoons of Coffee Rich® with ¾ cup of water

Milk substitute recipe: Well liked by many patients. Mix 1 cup coffee rich + ½ cup whipping cream + 1 cup cold water


Sodium


Sodium (Salt) Follow a reduced sodium diet and protect your;

• Kidneys

• Heart

How is it measured? Sodium level is not measured by blood work. Some patients will experience

swelling when they eat too much sodium. A diet high in sodium can be

harmful to the heart and kidneys.

All kidney patients should reduce the amount of sodium they eat.


Sodium (Salt) An important step towards better health includes limiting

foods and beverages that are high in sodium. Health

Canada now states that all Canadians would benefit from

reducing their sodium intake. Today’s Canadian diet can provide up to 2-3

times more sodium than what is recommended.

When kidney function decreases, the build up of sodium can interfere with

the body’s ability to regulate its water content resulting in excess fluid in

your body. The build up of fluid may cause an increase in blood pressure,

swelling of the feet/hands/face as well as shortness of breath. Since high

blood pressure can further damage your kidneys, it is recommended that

you limit your sodium intake to less than 2300 mg per day.

Most of the sodium we consume is hidden in the foods we eat!

The salt shaker will provide about 10 % of our sodium intake while

processed foods contribute about 80%. Be aware that “salt is sodium”.

Table salt, kosher salt and sea salt are all sodium!


Tips to reduce sodium in your diet:

• Avoid adding salt during cooking and do not salt food at the table.

• Avoid table salt and seasonings that contain salt (e.g. garlic salt).

• Do not use salt substitutes such as: “No Salt®” if you are following a

reduced potassium diet.

• Avoid processed meats such as bacon, ham, sausages, hot dogs, lunch

meats, canned meat.

• Avoid processed foods such as heat and serve meals. Avoid salty

snacks such as salted crackers, nuts, chips.

• Avoid canned soups, frozen dinners, instant noodles, instant rice mixes.

• Avoid bottled sauces, pickles, olives and MSG (found in some Chinese

foods).

If choosing frozen foods look for ones with 600 mg of

sodium or less.

Choose sauces, salad dressings, condiments or snack

foods with 150-200 mg of sodium/serving or less.

Read labels; Sodium Reduced/Low Sodium products are

often high in potassium. Potassium chloride is often used

to replace sodium in food products. If you are following a

reduced potassium diet, it is important you avoid these

products.


High Sodium Food List The following is a list of high sodium foods. It is recommended that you avoid eating these foods. There are many lower sodium choices in the grocery store. If you are following a reduced potassium diet read the food labels to avoid added potassium. Potassium is often used to replace sodium.

Processed Meats

Seasonings Canned Goods Other Foods

• bacon • back bacon • bologna • chicken • corned beef • devilled ham • ham • hot dogs • liverwurst • mock Chicken • paté • pastrami • pepperoni • roast beef • salami • smoked meat • turkey • sausage • Spam®

• Accent® • BBQ sauce • Bovril® • baking soda • celery salt • chili sauce • garlic salt • ketchup • onion salt • MSG • meat tenderizer • prepared

mustard • relish • salt • sea salt • soy sauce • steak sauce • steak spice* • Shake & Bake® • taco sauce • tamari sauce • teriyaki sauce • worcestershire

sauce

• sauces • vegetables • soup • consommé • dry soup • gravy • sauerkraut • spaghetti

sauce • tomato paste • tomato sauce • tomato juice • V8® • Clamato® juice• Garden

Cocktail®

• bouillon • broth • Cheez Whiz® • chips • chinese food • cottage cheese • frozen waffles • frozen/instant

pancakes • olives • packaged rice & pasta

mixes • pickles • pickled Beets, onions • pizza • pretzels • processed cheese • ready-to-eat cereal • salad dressing • salted nuts and seeds • salted crackers • smoked, salted or

dried fish (anchovy, caviar, smoked salmon, pickled herring, sardines)

• tea biscuits • TV dinner/frozen meal


Watch for new food items in the grocery store. Many food manufactures are now offering “reduced in sodium”, “low

sodium” or “no added salt” versions of their products.

Look for;

no added salt canned vegetables.

*low sodium V8®.

*reduced in sodium tomato juice.

low sodium or no added salt canned salmon or tuna.

low sodium or no added salt butter or margarine.

*these foods are high in potassium. Avoid if you are following a low

potassium diet.

If you are following a reduced potassium diet read the ingredient

list on label. Manufacturers will often lower sodium by replacing it with

potassium chloride; while this will lower your sodium it will increase your

potassium.


Spice Up Your Diet: Tips for adding Flavour Adapted from the National Kidney Foundation

Giving up sodium does not mean giving up flavour! Learn to season your

food with herbs and spices. Be creative and experiment for a new and

exciting flavour.

What kind of spices and herbs should I use instead of salt to add flavour?

Try the following spices with the foods listed:

Spice Use With

Allspice beef, fish, beets, cabbage, carrots, fruit

Basil beef, pork, most vegetables

Bay Leaf beef, pork, most vegetables

Caraway beef, pork, green beans, cauliflower, cabbage, asparagus,

and dips and marinades

Cardamom fruit and in baked goods

Curry beef, chicken, pork, fish, green beans, carrots and in

marinades

Dill beef, chicken, green beans, cabbage, carrots, and in dips

Ginger beef, chicken, pork, green beans, cauliflower and eggplant

Marjoram beef, chicken, pork, green beans, cauliflower and eggplant

Rosemary chicken, pork, green beans, cauliflower and eggplant

Thyme beef, chicken, pork, fish, green beans, beets and carrots

Sage chicken, pork, eggplant and in dressing

Tarragon fish, asparagus, cabbage, cauliflower and in marinades


Other Suggestions: Food Types of spices

Fruit allspice, cinnamon, cloves, mint, cardamom, ginger and

nutmeg

Beans basil, cayenne, chili powder, cloves, coriander, cumin,

marjoram, oregano, paprika, rosemary, savory, thyme and

tumeric

Beef coriander, basil, garlic, parsley, cumin, horseradish,

marjoram, dried mustard, oregano, paprika, rosemary,

savory and thyme

Carrots or

Winter Squash

allspice, anise seed, cardamom, cinnamon, cloves, cumin,

dill, ginger and tarragon

Eggs basil, chili powder, cumin, curry, dill, marjoram, paprika,

tarragon and thyme

Fish cumin, basil, chives, chives, fennel, dried mustard, garlic,

dill, ginger, oregano, paprika, saffron, tarragon and thyme

Potatoes basil, cayenne, curry, dill, horseradish, oregano, paprika,

rosemary and tarragon

Poultry coriander, allspice, basil, garlic, cumin, curry, dill, ginger,

marjoram, dried mustard, paprika, rosemary, saffron,

sage, tarragon, thyme and tumeric.

Vegetables basil, cumin, ginger, paprika and tarragon


Purchase spices and herbs in small amounts. When they sit on the

shelf for years they lose their flavour.

Use no more than ¼ tsp of dried spice (¾ tsp of fresh) per pound of

meat.

Add ground spices to food about 15 minutes before the end of the

cooking period.

Add whole spices to food at least 1 hour before the end of the cooking

period.

Combine herbs with oil or butter, let set for 30 minutes to bring out their

flavour, and then brush on foods while they cook, or brush meat with oil

and sprinkle on herbs 1 hour before cooking.

Crush dried herbs before adding to foods.


Can I use salt substitutes? Caution! Some salt substitutes are a mixture of table salt such as Half

Salt® while others contain potassium such as No Salt®. If you are on a

reduced potassium diet, avoid using salt substitutes.

Seasoning Blend Recipes

Seasoning blends such as Mrs. Dash® are a great way to season foods

without salt. You can make you own seasoning blends. When using the

following seasoning blend recipes, make sure to blend well. Place in a

shaker. Experiment and create your own seasoning containing those

spices that you like.

American Favourite Spicy Seasoning

5 tsp onion powder (not onion salt) 3 Tbsp celery seed 1 Tbsp garlic powder 1 Tbsp onion powder 1 Tbsp paprika 1 tsp garlic powder 1 Tbsp dry mustard 2 Tbsp crushed thyme 1 tsp thyme 1 ½ tsp ground bay leaf ½ tsp white pepper 1 ½ tsp black pepper ½ tsp celery seeds 1 ½ tsp ground cloves Yield: about ¼ cup Yield: about ½ cup Seafood Herb Mix Spice Blend for Meats Mix equal parts: Mix equal parts: Chives Celery seeds Marjoram Crushed red pepper Parsley Dill seeds Savory Garlic powder Tarragon Ground black pepper

Ground white pepper Mustard seeds Thyme


Soups and Your Kidney Friendly Diet

Most canned and dried soups are high

in sodium. Most restaurant soups are also

very high in sodium. Whenever you can,

avoid these products. If you do eat some high

sodium soup, avoid other salty foods for the rest of that day.

Avoid

• Tomato based soups.

• Dried Soups mixes.

• Soups that contain legumes (split pea, kidney beans, lentils, navy beans

etc.), cheese or mushroom as these are high in phosphorous.

• Dried onion soup mix or bouillon cubes or powders in recipes.

Choose

Reduced sodium soups containing less than 500 mg of sodium per bowl.

Luda “No Added Salt instant bouillon mix”

This product is not high in potassium and is reduced in sodium. This

product contains 330 mg of sodium in a tablespoon compared with 1200

mg of sodium in a regular bouillon cube or 1060 mg of sodium in 1 tbsp of

dried onion soup mix.

Luda can be purchased at the following stores:

Loblaw’s- 481 Gibb St. Oshawa and 1792 Liverpool Road, Pickering

Real Canadian Superstore, 30 Kingston Road, Ajax

20 Taunton Road, Whitby

It may also be ordered on line at:

www.ed-foods.com/onlineorders_soups_C.html


Remember that milk adds both potassium and phosphorous to

your diet. If you are on a reduced potassium diet, avoid soups containing,

potassium chloride, are tomato based or contain other ingredients high in

potassium.

Check your local grocery store for lower sodium ready made

soups. A lower sodium soup contains less than 500 mg per 250 mL (1 cup)

serving.


Protein


Protein

Follow the suggested amount of protein and protect your: Kidneys

Your body health

How is it measured? • Albumin level in the blood monitored by a blood test.

Albumin level in blood:

Target for all patients is 35-45 g/L.

Dietitians may also ask you to complete a diet history to assess the

amount of protein you are eating.


Protein and Your Kidneys Protein is a nutrient found in many foods. The best quality proteins are

found in animal products. Protein is important for the growth and

maintenance of body tissue. Protein also plays a role in fighting infection,

healing of wounds and provides a source of energy for the body. It is

important to eat the right amount of protein each day. Your protein needs

will vary depending on your body size and how well your kidneys are

working. Protein foods also contain fat. Choose lean protein foods and

adding little or no added fat.

Examples of Protein foods:

Best Choices Avoid high in phosphorous and sodium

Hard Cheese (limit to 3oz/week) Chicken Duck, Goose, Quail Eggs (limit to 3 egg yolks per week)

egg substitute Fish –fresh, frozen, canned* (remove the bones)

Lamb Lean Beef –steak, roast, ground beef

Pork –roast, loin, chop Shellfish –crab, lobster, shrimp, Turkey: fresh (avoid self pasting) Veal Wild Game –rabbit, venison

• Bacon/ back bacon • Hot dogs • Luncheon meats (ham, bologna,

salami, corned beef) • Salted or pickled meats (pork,

herring, salt cod) • Sausages • Salted, smoked, cured or

canned meat • Organ meats (liver, brain,

kidney) • Legumes and dried peas and

beans ( hummus, tahini, dahl, falafel, split peas, bean soup)

• Processed cheeses(cheese spread, slices)

*Choose low sodium or no added salt products when ever possible. Avoid tenderized, preseasoned or marinated meats as these contain sodium and added phosphorous.


How much protein do I need?

Your Dietitian will help you determine how much protein you need to eat

everyday.

Measuring Tip: 1 egg is equal to 1 ounce of protein and 3 ounces of

protein is about the size of a deck of cards. 1 oz is a slice of meat the size

and thickness of a CD. The following chart describes cooked meat.

I need each day: ___________oz/day

1 oz (30g) 2 oz (60 g) 3 oz (90g) Size of deck of cards

• 1 large egg (limit to 3 yolks per week)

• 1 inch cube hard cheese or 3 Tbsp grated cheese (limit to 3 oz per week)

• 1 slice cooked meat (4"x2"x1/4")

• 1 chicken wing • 1/4 cup dry curd cottage

or ricotta cheese • 1 small lamb chop • 1/4 cup canned fish (no

bones) • 3 medium shrimp • 1/4 cup crab, lobster,

shrimp • 1/3 cup tofu

• 1 chicken thigh or drumstick

• 1 small pork chop • *2 slices low sodium

meat • ½ cup cooked lean

ground meat • 1/2 cup canned fish (no

bones) • 1/2 cup dry curd cottage

cheese • 1/2 cup crab, lobster,

shrimp

• 1 small chicken leg (thigh and drumstick)

• 1 medium pork chop • 1 small boneless

chicken breast • 1 medium fish fillet

(3"x2"x1")

* read labels avoid potassium chloride if you are following a low potassium diet.


When Choosing Protein Foods

Choose:

Unmarinated, unseasoned fresh or frozen meats: beef, pork, veal, lamb,

venison, rabbit, goat. Avoid precooked, preseasoned / flavoured or

prepared meat products.

Eggs – egg whites are an excellent source of protein. You may eat as

many eggs whites as you wish. Egg yolks are high in phosphorous, limit

your intake of egg yolks to 3 yolks per week.

Hard cheeses such as cheddar or mozzarella are high in salt,

phosphorous and fat. Limit to 3 oz per week.

Lower fat cuts of meat and trim any visible fat.

Low fat cooking methods: bake on a rack, broil, BBQ, grill or fry with

cooking spray or water.

Avoid

• Meats that are marinated, self-basting, seasoned or tenderized.

• Avoid all processed cheese products such as cheese slices and

spreadable cheese products such as Cheese Whiz®.

If you follow a vegetarian diet, ask your dietitian to help you

include appropriate choices in your meal plan.



Potassium


Potassium:

I currently need a reduced potassium diet.

YES Date: ______________

NO Date: ______________ Follow the suggested amount of potassium and protect your:

• Heart Too little or too much potassium can be very hard on the heart. You should

only restrict your potassium if it is suggested to you. Restricting potassium

when it is not needed will NOT help the kidneys!

How is it measured? • Potassium level is monitored by lab tests.

Potassium levels in blood:

Minimum of 3.2 to 3.5 mmol/L depending on the lab you visit.

Maximum of 5.0 to 5.5 mmol/L depending on the lab you visit.


Potassium and the Kidney Friendly diet.

Potassium is a mineral that the body uses for the regulation

of muscle activity, including the heart muscle. Healthy kidneys ensure the

right amount of potassium is kept in the blood and the extra potassium is

filtered out. When the kidneys are not working properly, potassium levels

may begin to build up in the blood.

Why is this important to monitor potassium levels?

Too high or too low potassium can cause irregular heart beats and may

even cause the heart to stop. Keeping potassium within a normal range is

very important.

Your potassium level is monitored at each clinic appointment by the health

care team. A simple blood test helps us keep track of your potassium level.

If your potassium level is high, you will need to restrict your intake of high

potassium foods. If your potassium level is low, you will need to eat more

high potassium foods.

Where does Potassium come from? Potassium is found in most foods. Foods such as fruits, vegetables, milk

and milk products and grains have higher levels of potassium. A list of high

and low potassium foods is available on pages 58-60.


All foods contain some potassium, but some contain larger

amounts than others. Serving sizes matter. Eating large portions of low

potassium foods can cause a high potassium level in your blood.

How much Potassium do I need? A kidney friendly diet contains 2000-3000 mg or less of potassium each

day.

Should I just avoid vegetables and fruits? It is important to include vegetables and fruits in your diet every day. They

are important sources of vitamins and minerals needed to keep you

healthy.


Reducing potassium in potatoes Potatoes are naturally high in potassium. You can reduce the amount of

potassium in some vegetables by soaking them. This works particularly

well with potatoes, sweet potatoes, winter squash and pumpkin.

There is no need to soak all vegetables to lower potassium. Soaking will

remove other important vitamins and minerals.

Soaking or leaching can reduce the potassium in potatoes by almost half.

There are a few different soaking methods:

1. Soaking and boiling. 2. Double boiling. 3. Soaking only.

Each method is described; choose the one that fits your lifestyle. Each

method has a specific set of instructions. It is important to follow the

instructions for each method closely to ensure reduction in potassium. It is

important that you throw the water away, do not save it for making soups or

gravies.

Soaking and Boiling This is the most common method taught to kidney patients. You may

already be following this method.

1. Peel and cut the potato into 4 slices per potato, place in a large pot.

2. Cover with a large amount of water and soak the potato in warm water

for at least 2 hours.

3. Drain the water off, add fresh water and boil the potatoes until done.

4. Mash or fry the potatoes as desired.


Double Boiling This method results in a very soft potato that is, really only good for

mashing. This method is quicker than the other methods.

1. Peel and cut the potato into 4 slices per potato.

2. Cover well with water and bring to a boil.

3. Drain this water off and repeat step #2.

4. Cook potatoes until done.

Soaking Only Method The key to this method is to make sure the potatoes are cut into small

pieces and that a large amount of water is used.

1. Peel potatoes and cut-up into small pieces (½ inches or smaller).

2. Rinse in warm tap water.

3. Place potatoes in a large pot of water- the amount of water is very

important to ensure the potassium will be reduced. For every 1 cup of

cut potatoes add 10 cups of water.

4. Soak for 4 hrs.

Once soaked for the 4 hours, the potatoes can be added to any of your

favorite recipes or cooked in whatever way you wish (baked, boiled, fried,

and scalloped).


Low Potassium Potato Recipes The following pages are some examples of low potassium potato recipes.

These recipes are from the Davita web site (www.davita.com)

Almost mashed potatoes Makes 6 servings, each serving is ½ cup, each serving has 198 mg of

potassium

Ingredients:

6 cups of cauliflower (1 medium head)

4 oz of cream cheese (light or regular)

1 tsp minced garlic

½ tsp black pepper

Preparation:

1. Cut cauliflower into pieces and rinse with water.

2. Place cauliflower pieces in a microwave safe dish, cover and cook

on high for 8-10 minutes or until soft.

3. Drain off any liquid.

4. Add cooked cauliflower to blender and blend until smooth.

5. Add remaining ingredients and blend until smooth. Serve hot.


Garlic mashed potatoes Makes 4 servings, each serving is ½ cup, each serving has 161 mg of

potassium.

Ingredients:

2 large baking potatoes

2 garlic cloves peeled

¼ cup of margarine

½ cup of nondairy creamer

Preparation:

1. Soak potatoes.

2. Once soaking is complete, throw away soaking water and refill pot

with water, add garlic to potatoes and water. Boil until soft

3. Drain.

4. Add remaining ingredients to drained potatoes and garlic whip with

mixer and serve.

Freeze these in individual servings to enjoy any time.


Low potassium fried potatoes Makes 2 servings, each serving is 8 pieces, each serving has 181 mg of

potassium.

Ingredients:

2 medium potatoes

½ cup of canola oil

1/8 tsp ground cumin

¼ tsp paprika

1/8 tsp ground pepper

8 tsp ketchup

Preparation:

1. Slice each potato into 16 wedges.

2. Rinse potato slices and place in a pot with 3 liters of water- soak

for 4 hrs.

3. Heat oil in skillet, add potatoes to hot oil and cook for 10-12 mins

or until golden brown.

4. Once potatoes are cooked remove from oil, sprinkle with

seasoning mixture, and serve with a small amount of ketchup (2

tsp of ketchup per serving of potatoes).


Low potassium Scalloped potatoes Makes 4 servings, each serving is ½ cup, each serving has 161 mg of

potassium.

Ingredients:

2 cups soaked and diced potatoes

½ cup of nondairy creamer

1/8 tsp of pepper

2 tbsp of margarine or butter

2 tsp of all purpose flour

Preparation:

1. Place soaked potatoes in sauce pan add 4 cups of water and boil

until soft.

2. Drain, add ½ cup of hot water, nondairy creamer, pepper and

margarine, and bring to a boil.

3. Combine flour with 1 tbsp of cold water, add to potato mixture and

stir until thick. Serve hot.

Add onion or garlic to potatoes while boiling to add extra flavour.


Whipped Cauliflower and Potatoes Makes 5 servings, each serving is ½ cup, each serving has 178 mg of

potassium.

Ingredients:

1 cup of soaked potatoes

3 cups cauliflower

1 tbsp margarine or butter

¼ cup non dairy creamer

Preparation:

1. In medium size pot, boil cauliflower and soaked potatoes until

soft.

2. Drain and place in food processor. Add remaining ingredients

blend until smooth. ( can also be whipped using electric mixer)


Low potassium pasta sauces Another high potassium food is tomatoes. All tomato products are high in

potassium (tomato, tomato sauce, tomato past and tomato soup) a ½ cup

of tomato sauce has 450 mg of potassium in it. The following recipes are

lower potassium alternatives to pasta or tomato sauce.

Low Potassium Pasta Sauce

Ingredients:

7 roasted red peppers- pureed

1 fresh red pepper- chopped

1 large onion

2 – 6 cloves of garlic

1 eggplant- cubed

1 zucchini- cubed

¾ teaspoon salt

2 teaspoons sugar (optional)

1 – 2 teaspoons dry oregano

Chopped fresh basil and sage to taste.

Preparation:

1. In a large pot add all ingredients and simmer for 1-11/2 hours.

For increased protein, add meatballs or 1 pound cooked ground

meat.

2. Add water to sauce if too thick.

Sauce can be pureed and frozen to use for pizza and lasagna.

To roast red peppers: Place on aluminum foil and broil in oven

until blistered. Place peppers in a plastic bag to sweat them, and

then remove skins.


Chester's Roasted Red Pepper Sauce Ingredients:

8 fresh or frozen red peppers, whole

3 tablespoons vegetable oil

2 whole onions, chopped

4 cloves garlic, chopped

2 fresh basil leaves, chopped

2 tablespoons sugar

2 tablespoons lemon juice

2 tablespoons balsamic vinegar

SEASON WITH PEPPER TO TASTE

Preparation:

1. Roast whole red peppers and peel skins off. (To roast peppers,

place peppers on aluminum foil and broil in oven until skin blisters.

Place peppers in a plastic bag and allow to cool. Remove pepper

from bag and peel off skin.

2. Heat oil in pan. Sauté onions and garlic. Add peppers and

remaining ingredients and simmer for 1/2 hour, stirring

occasionally.

3. Puree ingredients using a blender or food processor.

Use sauce for pasta, lasagna, or on pizza.

For a high protein sauce add meatballs or cooked ground meat.


Potassium food lists The following pages are a list of low, medium and high potassium fruits and

vegetables. If it has been suggested that you follow a reduced potassium

diet, choose foods from the low and medium lists. If it has been suggested

to you to increase your potassium choose from the medium and high lists.

If you are following a low potassium diet, limit the following foods to lower

your potassium level

• Milk products intake limit to no more than 8oz (250 ml) per day.

• Cheese (avoid processed cheese) limit to 3 oz per week.

Remember to count milk used in coffee, tea, puddings, yogurt,

cream sauces, and soups as part of your milk intake for the day.

Other foods high in potassium that should be avoided

• Dried fruit or foods that contain dried fruits.

• Nuts and nut butters (peanut butter, almond butter).

• Foods containing nuts (breads, cookies, cakes).

• Chocolate or foods that contain chocolate.

• Whole grain, multigrain or dark breads.

• All bran or natural bran.

• Whole grain or multigrain crackers, cookies, or pastas.

• Foods made with tomato, such as soups, BBQ sauce, ketchup.

• Foods made with fruit puree such as steak sauce.

• Maple syrup.

• Pure licorice.

• Molasses.


Potassium food lists: FRUITS Fresh, frozen or canned: 1 serving = ½ cup or 1 small fruit (size of a tennis ball). Remember to DRAIN CANNED FRUIT

_________ SERVINGS PER DAY

Low Potassium (Less than 100 mg)

Medium Potassium (101-200 mg)

High Potassium (more than 200 mg)

Applesauce (90) Blueberries (65) Boysenberries(90) Cranberries (35) Lemon (80) Lime (70) Passion Fruit (60) Raspberries (95) Rhubarb (75) Watermelon (95)

Apple (160)Blackberries (140) Cherries (120) Clementine (131)Figs, Canned - 5 (145) Fruit Cocktail (120)Grapes (150) Grapefruit** - 1/2 (175)Lychees (170)Mandarins,canned(165) Peaches, canned (120) Peach, fresh (170)Pears, canned (120)Pear, ½ med fresh(105) Pineapple (135)Plum - 1 (115)Strawberries (125)Tangerine (130)

Apricots – 3 (315) Banana (450)Breadfruit (470)Canteloupe - ¼ (370)Dates (540)Figs, dried – 5 (665) Guava (255)Honeydew - ¼ (345) Jackfruit (300)Kiwi (250)Mango (320) Nectarine (290)Orange (250) Papaya (780)Persimmon (270) Plantain (360) Pomegranate (400)Prickly Pear (230) Prunes (350)Raisins (560) Soursop (310) Tamarind (380)

JUICES: cranberry cocktail (25) Lemonade (20)

Apple Juice (150) Grape Juice (170) Pineapple Juice (170)

Carrot Juice (360)Orange Juice (215)Prune Juice (355) *Tomato or V8®Juice (270)

**Check with your doctor or pharmacist – may interact with some medications. * Also high in Sodium.


Potassium food lists: VEGETABLES Choose fresh, frozen or no added salt canned. 1 serving = ½ cup _________ SERVINGS PER DAY Low Potassium (Less than 100 mg)

Medium Potassium (101-200 mg)

High Potassium (more than 200 mg)

• Alfalfa Sprouts (10) • Bean Sprouts • Cabbage (75) • Chives • Cucumber (75) • Endive (80) • Green Beans (85) • Leeks (95) • Lettuce (80) • Peppers (115) • Radicchio (60) • Watercress (55) • Yellow or Green

String Beans • Yellow Wax Beans

• Asparagus (145)• *Broccoli (230)• Carrots (180) • Cauliflower (150) • Celery, stalk (115) • Collards (170)• *Corn (120)• Dandelion Greens(120)• Eggplant (120)• Green Onions (140)• *Green Peas (150) • Kale (150)• Okra (190) • Onions (125)• Potato if prepared as

suggested on next page (~200)

• Radishes (105)• Snow Peas • Summer Squash –

Crookneck, Scallop or Spaghetti Squash (130)• Turnip (105)• Zucchini (160)

Artichoke -1 med (1060) Avocado (1480) Bamboo Shoots (320)*Baked Beans (453) Beets (260) Beet Greens (655) *Blackeye Peas (320) Bok Choy (315)*Broad Beans (310) *Brussel Sprouts (250) Cassava (765)*Chick Peas (240)*Kidney Beans (360)*Lentils (365)*Lima Beans (480) *Mushrooms (280) *Navy Beans (380) Parsnips (285) Potato (510) Pumpkin (280)*Soya Beans (445) Spinach (420)*Split Peas (355) Squash (Winter) – acorn, butternut, hubbard (445) Sweet Potato (330) Swiss Chard (480) *Tofu (300) Tomato (335) Tomato Paste (1230) Yams (455)

*Also higher in phosphorus.


Fluids


Fluids

I currently need to reduce the amount of fluid I drink:

YES Date:______________

NO Date:______________

Follow the suggested amount of fluid and protect your: • Heart

How is it measured? Each visit the nurse and doctor will check for swelling. If you are

experiencing swelling you may be asked to limit the amount you drink.

Unless you are instructed to limit your fluids, just drink to quench your

thirst. Drinking extra fluids will not “flush out” the kidneys or improve your

kidney function.

If you are asked to limit your fluids the amount is: 1 Litre per day + amount you void.

Following a low sodium (salt) diet will help reducing swelling. Eating too much sodium will make you thirsty.


Should I limit my fluid intake? A fluid restriction is not usually necessary during the early stages of kidney

disease. As kidney function declines, you may need to limit the amount of

fluids that you drink. If a change to your fluid intake is needed, your

healthcare team will let you know. Increasing or decreasing your fluid

intake on your own will not help your kidneys. Some things you may want

to consider limiting are caffeine, alcohol and nutritional milkshakes

(supplements).

Caffeine: Caffeine is found naturally in coffee, tea, chocolate guarana and yerba

mate. It is also added to foods such as energy drinks and cola-type

beverages.

Consuming too much caffeine can be harmful to your health. High intakes

of caffeine can cause sleeping problems, headaches, irritability and

nervousness. As well, many foods that contain caffeine are also sources of

potassium and phosphorous. A strong cup of tea (no milk added) has the

same amount of potassium as a 125 ml (½ cup) of blueberries. Adding milk

or cream would add extra potassium and phosphorous.

Health Canada recommends that all Canadians should limit their caffeine

intake to no more than 400mg per day.

How much is 400mg? Food item Amount of caffeine brewed coffee 250 ml (8oz) 135mg tea 250ml (8oz) 50 mg cola or diet cola 1 can 355 ml (12oz) 46mg Chocolate 20mg decaffeinated coffee 5mg


These numbers are just guides, the stronger you brew the coffee or steep

the tea the more caffeine it will contain. Most coffee shop cups are larger

than 8 oz.

Limit your coffee/tea intake to 3 servings of– 250ml (8oz) each per day

Remember to count milk or cream added as part of your daily milk

allowance.

Avoid specialty coffees, mochaccino, cappuccino, lattes, café au lait or

coffee powders (International coffees) these are high in potassium and

phosphorous.

Coffee alternatives such as Milo®, Postum®, Caflib®, Ovaltine®, Horlicks®

are also high in phosphorous.

Alcohol: If your doctor has approved the use of alcohol, please remember to use

moderation. Health Canada recommends the following:

No more than 1 to 2 alcoholic beverages per day for men.

No more than 1 alcoholic beverage per day for women.

One drink is 3.5 ounces wine, 1.5 ounces spirits or 12 ounces of beer.

Drinks are non-transferable. If you do not have a drink all week

that does not mean you can have all of them in one night.


The following are some things to consider:

Ales and lagers are high in potassium and phosphorous.

Liquors and spirits are lower in potassium and phosphorous. However,

mixes such as; orange juice, tomato juice, clamato juice are high in

potassium and colas are high in phosphorous.

Red and white wine are not high in phosphorous but contain potassium

(~140mg/glass).

Drinks with milk or cream are high in phosphorous and potassium

(Brown Cow, Pina colada, cream based liquors).

Nutritional Milkshakes (Supplements) There are many nutritional milkshakes available. Many of these contain

added potassium and phosphorous. If you are not able to meet your

nutritional requirements by food alone, a supplement may be

recommended.

Your Dietitian will let you know if a supplement would be of benefit to

you and will recommend which one will best meet your needs and be

friendly to your kidneys.

Not all supplements are kidney friendly so ask your Dietitian

before buying any over the counter supplements or diet products.



Diabetes


Diabetes Follow and manage your diabetes and protect your:

• Kidneys

• Heart

• Circulation

How is it measured? By two blood tests.

• A1C - determines your average blood glucose level for the past 3

months.

• Finger prick blood glucose (your meter) tells you what your blood

glucose level is right now.

Targets for blood glucose: A1C 7% or less

Blood glucose testing with your meter;

Fasting 4-7 mmol/L

2 hours after a meal 5-10 mmol/L

Test your blood glucose often, at least twice per day.

Test your blood glucose at different times (fasting, before

meals and 2 hours after a meal)

Write these down and bring to your clinic visits.


Cholesterol


Cholesterol

Follow a low fat diet and protect your: • Kidneys

• Heart

• Circulation

How is it measured? • A blood test, at least once per year.

Targets: Are individualized, speak to your healthcare team about what

your cholesterol and lipid levels should be.


Cholesterol and your kidneys Kidney patients have a higher risk of developing heart disease and are

often instructed to follow a cholesterol-lowering diet. Eating a heart healthy

diet while following a kidney friendly diet is challenging. For example a

heart healthy diet suggests you eat high fibre foods such as 100% whole

wheat breads, yet your kidney friendly diet is low in phosphorous and

recommends that you avoid these products! The Dietitian can help you plan

a heart healthy kidney friendly diet. Here are some heart healthy, kidney

friendly suggestions;

Choose

High fibre kidney friendly foods (page 72).

Low fat such as low fat breads, cereals and grains.

Healthy fats such as non hydrogenated margarine, olive oil.

Omega 3 fats (page 73).

1%, 2% milk or less milk products and yogurt.

Lean fresh meats, such as skinless chicken breast, pork tenderloin, and

extra lean ground beef. Cook without adding oil or other fats.

• Limit hard cheeses to 3 oz per week (look for light or skim milk).

• Exercise regularly, a heart healthy exercise regime includes both

cardiovascular exercise (walking, swimming) and resistance training

(weight lifting). Ask your dietitians for more information regarding kidney

friendly exercise.

• Take your cholesterol medications as suggested by your health care

team.

• Speak to your health care team before taking a cholesterol lowering

agent over the counter or herbal remedies.


Fibre Food Choices for Kidney Patients Aim for at least 5 servings of fruits and vegetables daily. Choose the fresh

fruit or vegetables rather than juice to get the benefit of fiber. Remember to

take note of the portion size to avoid eating too much potassium and

phosphorus.

Food Group GOOD FIBRE CHOICE (<3g fibre per serving)

BEST FIBRE CHOICE (>3g fibre per serving)

Fruits and Vegetables

• ½ cup canned pear

• ½ cup fruit cocktail

• *1 cup canned mandarins

• ½ cup canned peaches

• Medium fresh peach

• *1 small tangerine

• 1 cup fresh strawberries

• 1 medium plum

• ½ cup canned pineapple

• ½ cup asparagus

• ½ cup boiled cauliflower

• ½ cup boiled green/yellow beans

• 1 cup raw snow peas

• 1 cup raw zucchini

• ½ cup boiled cabbage

• 1 cup raw savoy cabbage

• ½ cup boiled corn

• ½ cup boiled carrots

• ½ cup frozen mixed veggies

• Fresh apple with skin

• Fresh pear with skin

• ½ cup fresh

blackberries

• 1 cup fresh blueberries

• ½ cup fresh raspberries

• 1 cup applesauce

• ½ cup frozen boiled

broccoli

• 1 medium stalk broccoli

raw

• 1 cup stewed rhubarb

• ½ cup boiled green

peas

• 1 cup boiled white

turnip


Omega – 3 Fats Omega 3 fats have become famous for being helpful in a number of

health conditions. The best known reason to increase your intake of

omega – 3 fats is to decrease your risk of heart disease. Other reasons

include; reducing your risk of some cancers, treating arthritis and macular

degeneration of your eyes.

Some sources of Omega- 3 fats are also high in potassium and

phosphorous and thus need to be avoided. These include; flaxseeds

(whole or ground), sardines, anchovies and pickled fish such as mackerel

and herring.

One of the best sources of Omega-3 fats is fish. It is recommended by the

Heart and Stoke foundation that Canadians aim to eat fish at least 3 times

per week.


Kidney friendly Omega- 3 choices

Atlantic salmon – fresh or frozen

• Do not use smoked salmon as it is high in sodium and does not contain much omega – 3

• Atlantic salmon contains less mercury • Wild is better than farmed

Canned salmon • Pink salmon is better than sockeye for omega – 3

• Look for lower sodium versions • Remember to take the bones out

Tuna – fresh Tuna – canned

• Choose bluefish, not yellow fin • Choose albacore or white • Choose one that is canned in water • Look for lower sodium ones

Rainbow Trout Bluefish Mackerel – fresh or frozen

• Pacific and Jack are higher in potassium • Atlantic mackerel is fine

Flaxseed Oil • Whole flaxseed and ground flaxseeds are higher in potassium and phosphorus but the oil is fine to use and contains the same amount of omega – 3 as Atlantic salmon (fish is still believed to be more effective though)

Omega 3 enriched eggs Omega pro egg substitute

• By using the egg substitute, you are also cutting down on fat and cholesterol

Omega 3 enriched milk Omega 3 enriched cheese

• If you use these products, remember to only use them in the amounts suitable for your kidney diet

Fish Oil Pills • Speak with your doctor or pharmacist first. • Generally it is suggested to use 1 gram of fish

oil daily. You may also need to take 200 IU of vitamin E with it ( need to check with pharmacist about this)


What’s for dinner!


Low Potassium, Low Phosphorous, Low Sodium Fast Food Tips

Adapted from the National Kidney Foundation. When pressed for time we often choose food from fast food restaurants.

There are so many items to choose from but which ones fit into your kidney

diet?

• Choose meats served without sauces or gravies. Broiled, steamed or

grilled items are better then deep fried foods. Trim the fat and remove

skin before eating. Most batters or coatings are high in salt. Avoid

smoked or processed meats such as hot dogs, sausages, pepperoni

and cold cuts like salami and pastrami.

• Remember that french fries and baked potatoes are high potassium

foods. Why not try rice, noodles, or side salad. Onion rings are a low

potassium alternative to choose occasionally (high in sodium and fat).

• Keep in mind that ketchup, BBQ sauce and pickles are high in sodium.

Keep condiments, special sauces and dressings to a

minimum by requesting these to be served on the

side. This will let you control how much you use.

• Drink sizes are usually large or extra large and

can contribute to fluid overload if you have a

problem with swelling and must limit your fluids.

Order a small drink and remember to avoid cola pops to limit your intake

of phosphorous. If you choose milk, count it as part of your milk

products allowance for the day.


• Choose white or 60% whole wheat breads or light rye breads or rolls.

plain bagels, sourdough, french, or italian breads are also good choices.

• Avoid: premade macaroni, potato salads, bean salad and creamy

dressings. These are very high in sodium and potassium.

• Italian Foods - choose plain pasta and meats served without cream or

tomato sauces. A pesto sauce is lower in potassium. Limit pizza to one

slice and add bread and salad to complete the meal. Stick to lower

potassium, lower sodium toppings such as

pineapple, peppers, chicken, and ground meat.

Avoid pepperoni, sausage, tomatoes,

mushrooms and anchovies. Ask for pesto sauce

to be used instead of tomato sauce on your

pizza. If this is not available request a small amount of tomato sauce to

be used.

• Chinese/ Thai/Japanese Food - Look for restaurants that do not use

MSG. Avoid using extra soy sauce. Avoid dishes that contain nuts. If you

are reducing potassium, be aware that many Chinese greens such as

bok choy are high in potassium. Choose steamed rice instead of fried to

reduce sodium.

• Sandwich/Sub Restaurants – What a perfect place for a kidney diet. You

can custom order your sandwich with roast beef, turkey, chicken, tuna

and lower potassium ingredients such as lettuce, peppers, onions,

cucumbers or pineapple. To limit sodium, avoid BBQ, sub sauce, pickles

and hot peppers. Many sub shops now offer salads as well, remember

to choose low potassium vegetables (avoid tomatoes).


• Burger Places – Many have healthier menus now. Choose the grilled

chicken or grilled burger on a bun or flat bread and skip the fries, bacon

and tomato. To limit sodium use small amounts of

toppings such as ketchup, and relish. Use pickles and

hot peppers sparingly. Have a side salad (with

dressing on the side) or as a treat, enjoy a small

order of onion rings (high sodium and fat).

• Donut Shops – Choose yeast raised donuts that do not contain

chocolate, nuts or high potassium fruits. Bagels are also great choices

(avoid whole wheat, raisin or nuts). Many coffee shops now offer

sandwiches and soup. Be aware that soups are high in sodium and may

contain high potassium ingredients. Follow the same guidelines above

for sub restaurants.


Kidney friendly choices at Donut shops The following choices are allowed in moderation. Although these choices are lower in potassium, they are higher in phosphorous, sodium, fat and calories.

Bagels • Plain • Blueberry • Onion • Cinnamon raisin (avoid if following a

low potassium diet) Cream Cheese • Plain light or regular • Strawberry • Herb and garlic • Garden vegetable

Sandwiches For all sandwiches

White NOT multigrain bread Regular size NOT large No tomato

• Turkey breast - avoid dressing ask for mayo or mustard instead.

• Tuna salad • Chicken salad • Egg salad Baked Goods

• Plain croissant • Apple danish • Cherry cheese danish • Blueberry cheese danish

Soups (10 oz serving) Still HIGH in SALT These are lower in potassium Chicken noodle • Turkey & rice Yeast Raised Donuts And Tim Bits

• 3-4 Tim Bits = 1 donut • Apple fritter • Blueberry fritter • Dutchie • Honey dip, honey crueller • Strawberry filled • Blueberry filled • Raspberry filled • Lemon filled

Beverages • Coffee • Decaffeinated coffee • Tea • Apple juice • Milk (remember to count as part of

your daily milk products)


Kidney Friendly Snack Choices

The following are some low phosphorous, low potassium and low sodium

ideas for between meals snacks. pretzels, unsalted (1c) popcorn, plain (1½ c) bread Sticks (2) english muffin (1/2) plain bagel with 1tbsp cream cheese (1/2 bagel) graham crackers/wafers (4 squares) rice or corn chex cereal (1c) fruit cocktail (1/2c) apple (1 small) blueberries (1c) oatmeal♣ or cream of wheat cereal- not instant (1/2c) vanilla wafers (4) shortbread cookies or vanilla sandwich cookies (4) grapes (15 small) fruit pie (1/8 pie) yeast raised donut (1 plain) cereal: rice krispies, cornflakes, special K (1c) angel food cake (1 med slice) pound cake, unfrosted (1 med slice) popsicle (1 bar) frozen fruit juice bar (1bar) sorbet (1/2c) raw veggies with low fat dip (1/2c) fresh fruit (1 small piece or ½ c) yogurt (1/2c)- remember to count as part of your milk products allowance for the day

plain rice cakes (2) cracked wheat or light rye bread with jam (1 slice) jello rice krispies squares

♣ limit oatmeal to 3 times per week to limit your phosphorous intake


Shopping


Reading Food Labels The following information will help you read the new labels and decide

which foods you can include as part of your kidney friendly label diet.

Ingredient List

The list of ingredients is mandatory. All of the ingredients for a food are

listed in descending order by weight with the largest listed first.

Serving Sizes

The serving size is what a single portion of a food is. The information

stated on the label is based on the serving size. Be aware that the serving

size on the label may not be the same as the portion you are going to eat.

Calories

Calories tell you the amount of energy found in a serving of the food

Percent of Daily Value (% Daily Value)

This puts the nutrients on a scale of 0% to 100%. This scale tells you if

there is a little or a lot of a nutrient in a serving of this food. See page 86

what % of each nutrient is best for your kidneys.


Fat and Cholesterol

Many patients with kidney disease are also following a diet to lower their

cholesterol. Look at fat and cholesterol daily values to choose heart

healthy foods. You can lower your blood cholesterol level by limiting the

amount of cholesterol, and saturated fats you eat. Look for foods with less

than 10% of daily value of saturated fat and less than 7% daily value of

cholesterol per serving. Choose lean meats and trim visible fat.

Trans Fats

Trans fat (also called trans fatty acids) is formed when liquid vegetable oils

go through a chemical process called hydrogenation, a process that makes

oils more solid. Hydrogenated vegetable fats are used by food

manufacturers because they allow longer shelf-life and give food desirable

taste, shape and texture.

The majority of trans fat can be found in shortenings, stick (or hard)

margarine, cookies, crackers, snack foods, fried foods (including fried fast

food), doughnuts, pastries, baked goods, and other processed foods made

with or fried in partially hydrogenated oils. Some trans fat is found

naturally in small amounts in various meat and dairy products. To lower

your intake of trans fats, avoid hydrogenated oils or food prepared with or

that contain hydrogenated fats.


Sodium

Sodium is another word for salt. Patients with kidney disease should limit

their intake of sodium. In general look for foods that have no more than 6-

10% of the daily value for sodium. Many low sodium products have added

potassium. If you are following a reduced potassium diet, read labels and

avoid low sodium products that contain potassium chloride in the ingredient

list.

Carbohydrates, Sugars and Fibre

If you have diabetes, this information is important for you. The total

carbohydrate grams per serving will help you with carbohydrate counting

and balancing your meals. Every 15 grams of carbohydrate equals one

bread/starch portion for a diabetic diet. Remember that foods with high

levels of fibre – at least 10% of the daily value will most likely be high

sources of phosphorous.

Protein

Protein is very important for keeping you healthy. Proteins are used by your

body to maintain and build tissues and cells. Label’s list the grams of

protein found in each serving. Each 7 grams of protein listed equal one

ounce of protein or one meat serving.

7 grams of protein = 1protein serving

14 grams of protein = 2 protein servings

21 grams of protein = 3 protein servings


Potassium

Potassium may be listed as percent daily values, but it is not mandatory on

the food label. If potassium is not listed, it does not mean that the food is

low in potassium. If percent daily values for potassium are listed, you can

use them to help with your diet. Percentages for potassium are based on

the reference standard of 3500mg. Your kidney friendly diet provides

approximately 2000-3000 mg per day.

In general:

Potassium low Potassium medium Potassium high

<100 mg 101-200 mg More than 200mg

<3% 3-6% 6% or higher

Phosphorous

Phosphorous may or may not be listed on the label, as it is not mandatory

on the food label. If phosphorous is not listed it does not mean the food is

low in phosphorous. Your kidney friendly diet is low in phosphorous, aiming

for 1000 mg or less per day. Foods that are described as “whole grain”,

“100% whole wheat” or those that contain bran, wheat germ, nuts, seeds,

or chocolate will also have higher levels of phosphorous.


PULLING IT ALL TOGETHER What you need to look for on a food label to determine if the food is kidney friendly Type of Food Serving Size Fat and cholesterol

Target: 65 gm fat and 300 mg cholesterol /day

Sodium(salt) Target is less than 2000-3000mg per day

Potassium ( if you need to restrict) Target is less than 1000 mg per day

Phosphorous

Target is less than

1200mg/day

Breads/Cereals/ Cookies/Muffins/ Snacking crackers

1 slice bread 2 cookies

8-10 crackers

6% daily value 150 mg

3 % daily value 10-100 mg

5-8% daily value or

less

60-120mg

Milk/Dairy Products ½ cup 3% daily value 60 mg

6% of daily value 200 mg or less

10% daily value or

less

125mg or less

Fruits ½ cup or 1 small piece

0 mg 5-7% of daily value 160-240 mg

1% or less of daily

value

16 mg or less

Vegetables ½ cup

Total fat less than 20% of daily value

Saturated fat-10% or

less of daily value

Cholesterol - 7% or less of daily value

1% daily value 23 mg

5-7% of daily value 160-240 mg

5% or less daily

value

60 mg or less

Protein – meat/fish/ Chicken/eggs/cheese

7 grams = 1 ounce/serving

(30 grams)

See list below 1% daily value 25 mg

2% of daily value 80 mg

8% or less daily

value

80 mg or less

Fats – margarine, mayonnaise Keep added fats( oil, margarine, mayo etc..) to 3-6 tsp per day

1 tsp Choose oil and margarines with

saturated fat- 10% or less of daily value

1% of daily value 50 mg

2% or less of daily

value

50 mg or less

Frozen dinners (for a main meal)

1 each 30% or less of daily value

20 grams

Under 20% of daily value

500 mg

27% of daily value 950 mg or less

50% or less of daily

value

Less than 600 mg


Grocery List Suggestions The following pages contain a grocery list to get you started on your kidney

friendly diet. If you don’t see a food you are wondering about, ask your

Dietitian.


Meat/Protein Foods Lean beef Skinless chicken Eggs Egg Substitute Fish Lamb Lobster Pork Shrimp Canned salmon (low sodium

Tuna (low sodium) Turkey Veal Wild Game

Fruits

Apple Juice Apples Applesauce Blackberries Cherries Cranberries Cranberry Juice Cranberry Sauce Fruit Cocktail Grape Juice Grapes Lemon Lemon Juice Lime Lime Juice Loganberries Lychees Peach Peach Nectar Pears (canned) Pear Nectar Pineapple Plums Raspberries Strawberries (½c)

Vegetables Alfalfa Sprouts Arugula Asparagus Cabbage Carrots Cauliflower Celery Chili Peppers Chives Coleslaw Corn* Cucumber Eggplant Endive Garlic Ginger root Green Beans Leeks Lettuce Mixed Vegetables Mushrooms* Onions Parsley Peas* Pimentos Radicchio Radishes Summer Squash (crookneck, zucchini)

Sweet Peppers (green, red, yellow, orange)

Turnip (purple one) Water Chestnuts Watercress Yellow Beans

Grain Products Bagels (White, 60% whole wheat, light rye)

Bread (white, Italian, French, Light Rye, cracked wheat)

Bread Sticks Cereal, plain Cream of Wheat Couscous Crackers (unsalted) English Muffins Hamburger Bun Macaroni Melba Toast Noodles Pita Bread Pasta (white) Popcorn (unsalted) Pretzels (unsalted) Rice (white) Rice Cakes Rolls Spaghetti Tortillas (flour)

Dairy/Dairy Substitutes

Non Dairy Creamers (Coffee Rich®)

Non Dairy frozen dessert topping (Cool Whip ®)

Rice Milk (not brown rice)

*High in Phosphorous


Beverages

7-up Sprite Gingerale Cream Soda Lemon-Lime Orange Crush Juice (apple, cranberry, grape)

Lemondade Mineral Water Tea Coffee

Fats

Butter Cream Cheese Margarine Mayonnaise Miracle Whip® Non dairy creamers Salad Dressings Vegetable oil

Seasonings and Spices

Allspice Basil Bay Leaf Caraway Seed Chives Cilantro Cinnamon Cloves Cumin Curry Dill Extracts (almond, lemon, lime, maple, orange, peppermint, vanilla)

Fennel Garlic powder Ginger Horseradish (root) Lemon Juice Mrs. Dash® Luda no added salt instant bouillon mix

Nutmeg Onion Powder Onion Flakes Oregano Paprika Parsley Pepper Pimentos Poppy seed Rosemary Saffron Sage Savory Sesame Seeds Tarragon Thyme Turmeric Vinegar

Desserts/Snacks/Sweets

Animal Crackers Cake (angel food, butter, lemon, pound, spice, white, yellow)

Chewing gum Cinnamon Drops Cookies (shortbread, sugar, vanilla wafers)

Donuts Fruit Ice Graham crackers Gumdrops Gummy Bears Hard candy Jell-O® Jelly Beans Jolly Ranchers® LifeSavers® Lollipops Marshmallows Pie (apple, berry, cherry, lemon, peach)

Other

Apple butter Corn Syrup Honey Jam Jelly Sugar (white or brown)

Adapted from “Grocery List Suggestions for Dialysis Patients” Abbott Laboratories, 2004



Other Helpful

Resources


Cookbooks for the Kidney Patient

Cookbook Author(s) Cost Ordering Details Cooking For David: A Culinary Dialysis Cookbook.

Sara Colman RD, CDE and Dorothy Gordon, BS, RN

$25.95US +tax/shipping

www.culinarykidneycooks.com Culinary Kidney Cooks P.O Box 468 Huntington Beach, CA 92648 Fax: 714-842-4694 e-mail: [email protected]

The Renal Gourmet

Mardy Peters $31.00 US (Includes shipping)

www.kidney-cookbook.com Emenar Incorporated 13n625 Coombs Rd Elgin, Illinois, 60123

The Renal Family Cookbook

Renal Family Inc (1983)

$15.00 CDN(includes shipping and handling)

www.multi-med.com/renal Multimed Publications 66 Martin St Milton, ON L9T 2R2 1-888-834-1001

A Taste of Asia: Cookbook for Renal Patients

National Kidney Foundation of Northern California

$10.00 US (includes shipping and handling)

National Kidney Foundation of Northern California 611 Mission St, 3rd Floor San Francisco, California, USA 415-543-3303 415-543-3331 (fax)


Cookbook Author(s) Cost Ordering Details Chinese Renal Kitchen, Cookbook for People Living with a Special Diet for Kidneys

BC Chinese Nutrition Consultants St. Paul’s Hospital, 1999 – 2nd Edition

$43.00 CDN St. Paul’s Hospital, Clinical Nutrition Room 4000 Providence Building 1081 Burrard Street Vancouver, BC V6Z 1Y6 604-806-9011

Creative Cooking for Renal Diets

Patricia Ellis, MS, RD

$17.95 US + shipping

www.patientsupport.net Book Masters 30 Amberwood Parkway Ashland, Ohio, USA 44805 1-800-247-6553

Creative Cooking for Renal Diabetic Diets

Cleveland Clinic Foundation (1985)

$17.95 US (+shipping)

www.patientsupports.net Book Masters 30 Amberwood Parkway Ashland, Ohio, USA 44805 1-800-247-6553

The Kidney Helper Cookbook

Bob and Nathalie Lutfy

$24.95 US + $4.00 shipping

www.consumermedhelp.com /KHMECookbook.html Consumer MedHelp Inc. 2437 Bay Area Blvd #128 Houston, TX , USA 77058 1-877-248-2331


Internet Resources The following are recommended internet sites that offer safe kidney friendly

nutrition.

The Kidney Foundation of Canada www.kidney.ca

The Kidney Foundation of Canada –Ontario Branch www.kidney.on.ca

The Kidney Foundation of Canada –Northern Alberta & The Territories Branch

www.kidney.ab.ca IKidney

www.ikidney.com

Kidney Directions www.kidneydirections.com/us/recipe

DaVita –Dialysis and Kidney Disease Information at Your Fingertips www.davita.com

National Kidney Foundation www.kidney.org

Epogen – 2 Free Kidney cookbooks to download www.epogen.com

Culinary Kidney Cooks www.culinarykidneycooks.com

American Association of Kidney Patients www.aakp.org


Measurement chart

Conversions:

2 tablespoons = 1 ounce (oz) = 30 ml

½ cup = 4 oz = 125 ml

¾ cup = 6 oz = 200 ml

1 cup = 8 oz = 250 ml

2 cups = 16 oz = 500 ml

4 cups = 32 oz = 1000 ml (1 Litre)



Exercise


Exercise

Follow an active lifestyle and protect your; • Overall Health

How is it measured? • Keep a record of your physical activity.

Target Be active every day.

Increase the number of minutes you are active slowly over time

Overall goal

Ultimate activity goal from the National Kidney Foundation,

Kidney Disease Outcome Quality Initiative is moderate intensity

for 30 minutes most, if not all, days per week.

Speak to a member of your health care team about how you can

increase your daily activity.


References


References

Kidney Diet Booklet. Association of Nephrology Dietitians of Eastern

Ontario/Western Quebec 1997

The Renal Diet: A Guide to Eating Healthier for Hemodialysis

Patients. VCU Health System, MCV Hospitals and Physicians, The

Hume-Lee Transplant Centre 2006

Kidney Friendly Comfort Foods: A Collection of Recipes for Eating

Well with Chronic Kidney Disease. Shire Pharmaceuticals, 2006

“Grocery List Suggestions for Dialysis Patients” Abbott Laboratories,

2004

Documents

Food for thought: Kidney Friendly Nutritioncentraleastlhin.on.ca/.../Kidney_Friendly_Nutrition.pdfA kidney friendly diet will reduce your daily intake of phosphorous to less than 1000