Chronic Kidney Disease Diet

Chronic Kidney Disease Diet

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Kidney disease is becoming more and more prevalent in America.  According to the National Kidney Foundation, 20 million Americans (1 in 9 adults) have chronic kidney disease.  With the use of non-steroidal anti-inflammatory drugs like ibuprofen and naproxen, ever increasing rates of diabetes, and uncontrolled high blood pressure, our kidneys are taking a beating.  Of course the most important step for your kidneys is to stop doing whatever you are doing to damage them.  Stop the ibuprofen, skip the sugars, and get your blood pressure under control.  Sounds like the Paleo diet is a great preventative measure for chronic kidney disease.

The first step in a diet for people with chronic kidney disease is to make sure you don't eat too much protein.  Protein intake in the Standard American Diet (S.A.D.) 15% of total calories consumed while Paleo folks consume 20% to 30% of their calories from protein.  This is way too much protein for someone with kidney disease.  Although there is still some debate on the benefits of a low protein diet in kidney disease, it appears prudent to limit the amount of protein consumed to 0.6 to 0.8 grams per kilogram of body weight.  This would be a striking reduction from the typical Paleo dieter.  

For example, if a 160 pound person consumed a 2,000 calorie diet on the Paleo diet they would generally eat between 100 and 150 grams of protein.  To put that in perspective, they would eat 14 to 21 ounces of meat or fish a day.  (An ounce of meat has approximately 7 grams of protein.)  So for breakfast they would eat a pork chop (22 grams), for lunch a chicken breast (30 grams), and for dinner some surf and turf of a 6 ounce steak and 3 ounces of salmon (63 grams) for a total of 115 grams of protein.  In this example they still had 5 ounces of meat to reach 150 grams or 30% of the total calories from protein.  Unfortunately, for this same person with chronic kidney disease they could only eat 44 to 60 grams of protein.  That would only be a 3 ounce pork chop and a chicken breast for the entire day.  (22+30=55 grams).  There is good news!  Eggs don’t count toward the total amount of protein.  So eat your eggs and enjoy.

People with chronic kidney disease also need to avoid phosphorus.  High levels of phosphorus in the blood will leach out calcium from the bones and increase the risk of low bone density and osteoporosis.  High levels of phosphorus is found in meats, dairy products, beans, beer, bran cereals, whole grain, corn, chocolate, nuts, seeds, and starchy vegetables.  Honestly, if you follow the Paleo diet you will avoid most of these food, but if you want a list of high phosphate foods you can search the internet or here is a link to the National Kidney Foundation website: http://www.kidney.org/atoz/content/phosphorus.cfm and here is one from the Mayo Clinic http://www.mayoclinic.com/health/food-and-nutrition/HQ01212

People with kidney disease should also limit their potassium and sodium.  If you are following the Paleo diet you should already be following a low sodium diet (watch that bacon), so no need to say any more about that.  Unfortunately, potassium isn’t as easy as sodium.  One of the benefits of the Paleo diet for most people is the high amounts of potassium, but for people with chronic kidney disease potassium can be a killer.  High potassium can do ugly things to your heart rhythm, so it is wise to be cautious.  Potassium intake should be around 1500 to 2700 mg a day for someone with kidney disease.  High levels of potassium can be found in many fruits, vegetables, milk, chocolate, salt substitutes, nuts, and seeds.  The best way to make sure you are not getting too much potassium in your diet is to keep a list of low potassium fruits and vegetables on hand and keep mostly to those.  There is also a way to soak your vegetables to reduce the amount of potassium in them.  To find a partial list of foods with high and low levels of potassium and how to soak your veggies refer to the National Kidney Foundation website: http://www.kidney.org/atoz/content/potassium.cfm or http://www.uptodate.com/contents/image?imageKey=PI/18470&topicKey=PI%2F4427&source=outline_link&search=diet+kidney+disease&utdPopup=true

With all this information what is a Caveman/woman to do?

First you need to determine your weight in kilograms by dividing your weight by 2.2 or going here: http://www.convertunits.com/from/lbs/to/kg

Second, you need to determine the range of protein you can have per day by multiplying your weight in kilograms by 0.6 and 0.8.

For example, a 160 pound person (160/2.2=73 kilograms (yes I rounded)) is 73 kilograms and I multiple 73 by 0.6 and 0.8 (73 * 0.6 = 44; 73 * 0.8 = 58) and for ease of use I round them up to the next whole number and in this case 44 and 60.  This gives me a total amount of protein per day of 45 to 60 grams for a 160 pound person.  Remember, eggs don’t count toward your total protein intake since they act on the kidneys by a different action, but they do have a moderate amount of phosphorus.

Now you need to decide which is easier to remember 7 grams of protein per ounce of meat or that a chicken breast has 30 grams of protein and a 6 ounce top sirloin steak has 50 grams and salmon has ... You get the point.  You need either a list of meats with amounts of protein or you need a scale and calculator.  Here is a website of high protein foods: http://lowcarbdiets.about.com/od/whattoeat/a/highproteinfood.htm, but there are many more lists on the internet or you can just plug everything into a free nutritional data base.  I like using the website Cron-O-Meter to plug my food into and it calculates all the numbers you need.  http://cronometer.com

Here is a sample 2,000 calorie diet for a 160 pound person.  Remember I am not a fan of counting calories, but for this example it is helpful.  Also, weight is the limiter on protein, but for potassium your real indicator is your blood levels which must be checked by your doctor.  

We are shooting for:

Protein 44-60 grams

Potassium 1500-2700 mg

Breakfast:

3 egg omelet with onions, green peppers, cooked in either coconut oil or olive oil (egg protein doesn’t count)

Bowl of blackberries, blueberries, strawberries

Lunch:

Salad with romaine, green peppers, radishes, chicken breast with olive oil and a splash of lemon juice

Apple

Celery with almond butter (nut protein doesn’t count either, but is high in potassium)

Snack:

Fresh pear and more berries

Dinner:

Salmon, grilled

Spinach salad with either walnut or olive oil and a splash of lemon

Cauliflower, boiled and drained with walnut or olive oil

Asparagus, cooked with olive oil

5 oz glass of wine

Total:

Calories: 1978

Protein from meat 50 grams

Potassium: 2728 (just a hair over)  If I substituted a little more chicken for salmon I might have made it.

This is a pretty tasty menu, I’d say.  Of course you can, and should, adjust this for your likes and dislikes and based on your actual weight, kidney function, blood potassium and phosphorus levels.  Ultimately this is just a suggested menu and your actual menu needs to be based on your actual blood chemistry.

One last note.  The above diet was not an easy exercise.  There are a couple of ways to make planning easier.  Write down the foods you like and the amounts of protein, potassium, and phosphorus.  Then rank them in order of nutrients from high to low.  You can then rank each food as high, medium, and low for each nutrient.  Then plan your meals allowing for more foods that are lower in each nutrient than medium and high.  Whenever you change your eating plan make sure you get follow-up blood work to confirm electrolyte and mineral levels.  Finally, if you need to add calories with a little protein, potassium, and phosphorus you can add white rice to any meal.  White rice will fill the caloric hole in the kidney based Paleo diet.  Make sure you always get plenty of fat with the rice to help slow absorption. Even a pat or two of butter won’t hurt.

Chronic kidney disease is a life changing condition.  Just like people with diabetes, heart disease, young, middle age, older persons, or athletes have to adjust their diets, so do people with chronic kidney disease.  Life is constantly changing and so will your diet as you progress from one stage to the next.  The Paleo diet will keep you as healthy and feeling as good as possible at each stage.

Please feel free to send me comments or ask questions for further clarification.

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