What is the Renal Diet?
Updated: Mar 30, 2020
A typical kidney friendly diet may not be a heart healthy diet, and heart disease is the most common cause of death among individuals with kidney disease.
In my private practice, I see a lot of people who have chronic kidney disease stages 3 (both a and b) who also have high blood pressure and/or high cholesterol.
Early in my career, I worked in kidney failure clinics for over 5 years where I was the Nutritionist on a kidney team and counseled many individuals with various stages of chronic kidney disease including chronic kidney disease stage 3, chronic kidney disease stage 4, and chronic kidney disease stage 5 diease and dialysis.
My patients were confused and rightfully so - they would oftentimes say, “the food for kidney health seems to be the opposite of what I thought a healthy diet is,” or “my doctor told me to eat white bread, white pasta and eliminate most fruits and vegetables from my diet.”
As a Registered Dietitian Nutritionist, Certified Diabetes Educator and Preventive Cardiology Dietitian, it made me upset to hear misinformation being taught by healthcare professionals and the internet.
I decided to devote a lot of my time to research the kidney diet. If the number one cause of death among kidney patients is heart disease – how can health care professionals advise against a heart healthy diet? (1)
This prompted me to create an educational campaign at the clinic to inform the medical community and patients of why this “old school” way of thought is the opposite way people who have chronic kidney disease should actually eat.
I changed and educated every healthcare professional and dietitian in my kidney failure clinic to provide more accurate diet advice of food for kidney health. In my private practice, I advise a kidney and heart healthy diet for those clients who have chronic kidney disease; and I have seen the significant improvements in a matter of 2 months!
Before we dive into how we can make a renal diet healthy, let’s review what a typical renal diet may look like.
What is the renal diet?
The renal diet is specifically created for people with compromised kidney function in order to reduce the work the kidney has to do. One of the kidneys main role is to filter the blood and maintain a balance of electrolytes, salts and minerals in the body (2).
When your kidney function declines, it affects the way the kidneys can process dietary intake of liquids, glucose, sodium, potassium, calcium, magnesium, phosphorus, and protein. If too much of any of these foods are consumed, it can tax the kidneys and cause an accumulation of toxins in the blood which can accelerate the progression of chronic kidney disease (3).
Therefore, it is advised to restrict fluid intake, carbohydrates, salt content, phosphorus, potassium and protein.
This can lead to removing fruits, vegetables, legumes, beans, and dairy from one’s diet which may leave many people with nutrient deficiencies, without many healthy food choices, and a confusion about what to eat for breakfast, lunch and dinner.
What is a typical renal diet menu?
The typical renal diet menu recommends white toast with jelly and margarine, rice krispies, roasted turkey or pork tenderloin, eggs with an occasional apple or a limited amount of carrots (4). Many diets are processed and with minimal amounts of fruits and vegetables which can worsen chronic kidney disease and accelerate heart disease formation leading to a heart attack or stroke.
It is important to note that a restrictive diet does not mean an elimination diet.
A low potassium diet does not mean a No Potassium diet. Every person has a different amount (measured in milligrams) of potassium they can eat based off their current kidney function, lab values and medications they take.
A low Phosphorus diet does not mean a No Phosphorus diet. Different types of phosphorus are found in dairy, legumes, beans, meat and processed foods. Studies have shown that the phosphorus found in plant based protein is less absorbable than animal protein, which has about 40-60% absorbable phosphorus. Foods that contain the processed form of Phosphorus has 100% absorbable Phosphorus which negatively impacts the kidneys the most (5).
A low protein or high protein diet is not inclusive of all stages of chronic kidney disease. The amount of protein will differ based on if you have chronic kidney disease stage 3, 4 or 5 not on dialysis, or on dialysis. A low protein diet is recommended for people who have chronic kidney disease stage 3, 4 or 5 pre-dialysis. This is because your kidneys may not be able to break down the protein efficiently causing an excess of ammonia in your blood which accelerates kidney failure. Once someone is on dialysis, they should be having more protein. Each person’s protein allotment will differ based off their body weight, kidney function and other health conditions (6).
The water debate is also not a clear one size fits all restriction. Some people urinate the same amount they always have, never get edematous and fluids may be beneficial to them. However, other people are unable to consume as much due to progression of their kidney function or from heart failure and need to measure their intake via food and liquid consumption water to avoid fluid to accumulate in their hearts, lungs and body.
The renal diet is confusing because there are many factors that come into the equation.
Some important questions I would need to know to properly personalize the right renal and heart healthy diet for you include:
What is your other past medical history? Do you have high blood pressure? Diabetes? High cholesterol? Hypothyroidism? Gout?
What are your blood values? What are you blood value trends?
Are you overweight? Obese? Underweight? What is your waist circumference?
How much renal function do you have? What is your estimated glomelular filtration rate?
What is your family medical history?
Do you have any symptoms? Are you tired? Lethargic? Weak? Edematous? Short of breath?
What medications are you taking?
It is important we ask these questions prior to accepting a blackened statement to avoid potassium, phosphorus, sodium and fluids because at the end of the day it will only lead to a white pasta, white rice, low fruits and vegetables diet that is worsening your kidney function and promoting heart disease.
To learn more about heart healthier kidney friendly foods, click here.
Here are just 3 examples of what I mean by what some health care professionals may typically recommend that can accelerate heart and kidney disease, and be a perpetuator of kidney progression, and heart attacks and stroke.
BREAD: Yes, it you want to look at the potassium and phosphorus content of both, white bread will have a little less but it will also be stripped of nutrients, increase your blood sugar levels (which negatively impacts your kidneys even more!) and attribute to unwanted weight gain.
I am not saying to go eat a whole loaf of whole wheat bread, but just 1 slice only has on average 55mg of phosphorus and 65mg of potassium, making it still a low phosphorus/potassium option that is more suitable to protect your heart and kidneys.
RED MEAT: I don’t know how this one came into the picture, but for some reason red meat was categorized be a more higher quality protein. However, the high concentrations of TMAO and saturated fat found in red meat actually accelerates heart and kidney disease much more quickly than any other animal protein consumed… let’s swap this for other alternatives like tofu instead.
And since some healthcare professionals pick and choose on which foods to count potassium and phosphorus content and which one’s not – let’s do a fair game and compare the two: Per 4 ounces, red meat has 260mg of phosphorus and 244mg of potassium while tofu only has 140mg of phosphorus and 145mg of potassium.
A lovely 75 year old woman, came to see me because she was petrified about hearing the diagnosis that she had ckd stage 3b and may have to go on dialysis. She was determined to halt her kidney disease progression through proper nutrition.
She came to me with over 50 pages of documents from her previous dietitian appointments, with lists of low potassium foods, low phosphorus foods and low protein foods. Her kidney disease had declined from an egfr of 48 to 32ml/min in a matter of months after implementing these new changes. She wasn’t sure what she was doing wrong.
She was not overweight but had gained about 5 pounds within the last year and she had a slightly increased waist circumference of 36 inches.
She joined my personalized VIP program and we worked together for 3 months to debunk kidney diseases diet myths and implement a realistic and positive diet change.
In 3 months, her egfr improved from 32 to 51, less protein was leaking in her urine, she lost those 5 pounds she had gained, decreased her waist circumference to 34 inches (to normal), and her doctor gave her the green light to come back in 6 months (instead of the regular monthly check ups), and he said to her: “if you maintain these numbers and behaviors, you won’t need dialysis.”
I hate to say it but many people still recommend a pro inflammatory diet (because it’s very low in potassium and phosphorus) which negatively impacts both your heart and kidneys.
The kidney diet is one of the most confusing diets to follow according to google - and unfortunately google has a lot of misinformation. Let me help you and your loved ones. Email me with any questions (firstname.lastname@example.org).
Schedule a complimentary 15 minute discovery call with me to see if we would be a good fit to work together.
People with chronic kidney disease need to avoid looking at kidney disease in isolation. The major cause of death for people with chronic kidney disease is heart disease and heart attacks. These can be avoidable through proper lifestyle medicine that targets both the kidneys and the heart.
The renal diet can be customized to you and your needs and still give you ample foods that will protect your heart.
Sign up for my newsletter to get more heart disease information! If you’re interested in working with me, send me an email or book a complimentary 15 minute discovery call - I would love to talk more about your needs.
In Health & Happiness,
Michelle Routhenstein, MS, RD, CDE, CDN
Preventive Cardiology Dietitian Owner of Entirely Nourished, LLC
P: (646) 979-0328 A: 276 Fifth Avenue, Suite 704, New York NY 10001
Disclosure: This article is for informational purposes only and not a substitue for indiviualized medical advice or treatment. Always seek the advice of a qualified health professional with any quesitons you may have regarding your health.
Sarnak et al. Kidney Disease as a Risk Factor for Development of Cardiovascular Disease. A Statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–2169.
Razmaria AA. Chronic Kidney Disease. JAMA. 2016;315(20):2248. doi:10.1001/jama.2016.1426.
National Institute of Diabetes and Digestive and Kidney Diseases. Nutrition for Advanced Chronic Kidney Disease in Adults. Published March 2014. Accessed June 11, 2019.
Diabetes Self Management. Sample Renal Diet. https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/kidney-disease/sample-renal-meal-plan/. Published December 9, 2013. Accessed June 11, 2019.
Noori et al. Organic and inorganic dietary phosphorus and its management in chronic kidney disease. Iran J Kidney Dis. 2010 Apr;4(2):89-100.
Ko GJ, Obi Y, Tortorici AR, Kalantar-Zadeh K. Dietary protein intake and chronic kidney disease. Curr Opin Clin Nutr Metab Care. 2017;20(1):77–85.
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