2014 Diet for Kidney Disease Name: Date: Dietitian: Telephone: Contents Introduction��������������������������������������������������������������������������������������������������1 Your meal plan����������������������������������������������������������������������������������������������2 Sample meal plan������������������������������������������������������������������������������������������3 List 1 – Milk and dairy List 2 – Vegetables List 3 – Potato List 4 - Fruit List 5 – Grain products List 6 – Meat & alternates List 7 – Fat Calories������������������������������������������������������������������������������������������������������13 Managing fluid intake�����������������������������������������������������������������������������������14 Fluid list High sodium foods to avoid���������������������������������������������������������������������������16 Foods with higher potassium content ������������������������������������������������������������18 High phosphorus foods���������������������������������������������������������������������������������20 Daily food intake�����������������������������������������������������������������������������������������21 Sample label for grains��������������������������������������������������������������������������������22 Introduction The main job your kidneys have is to get rid of waste products and fluid. Now that your kidneys have lost this function, following your diet is an important part of your treatment. Your diet helps to keep products (such as potassium, phosphorus, sodium and fluid) from building up in your body and making you sick. This diet is low in fibre. If you need more fibre in your diet, speak to your dietitian about over the counter supplements such as Benefibre® or flax, or ask your doctor about medications. This diet was made for you. If you want to eat food that is not listed in this book, your dietitian will help you. Tips: • Do not use salt when cooking or at the table • Do not use salt substitutes – Half Salt ®, No-Salt ® • Avoid processed and canned foods unless they are salt free • Read food labels • Avoid fast food restaurants 1 Your meal plan Diet order: Protein ______ gm Sodium ______ gm Potassium ______ mmol ______mg Phosphorus ______ mg ______mg Total daily food amounts: Food Amount Chose from: Milk and dairy List 1, page 4 Vegetables List 2, pages 4-6 Potato List 3, page 6 Fruit List 4, pages 7-8 Grain products List 5, pages 8-10 Meat and alternates List 6, page 11-12 Fat List 7, page 12 2 Sample meal plan Breakfast: ___ Fruit 1/2 cup applesauce ___ Meat / alternates ___ eggs ___ Grain products ___ slices white toast and/or ___ cup Cheerios® ___ Fat ___ tsp margarine and jam ___ Milk / dairy ___ Tea / coffee ½ cup coffee with 1 Tbsp milk or cream Morning snack Noon meal: ___ Meat / alternates ___ cup tuna ___ Grain products ___ slices white bread ___ Fat 1-2 tsp mayonnaise or margarine ___ Fruit 14 grapes ___ Milk / dairy ___ Tea / coffee ½ cup tea with 1 Tbsp milk or cream ___ Extra foods Afternoon snack Evening meal: ___ Meat / alternates ___ Grain products ___ Potato ___ Vegetables ___ Fat ___ Fruit ___ Milk / dairy ___ Tea / coffee ___ Extra foods ___ oz chicken breast (baked) ___ white roll ½ cup mashed potato ½ cup carrots and ½ cup green beans 2 tsp margarine ½ cup strawberries ½ cup tea with 1 Tbsp milk or cream Evening snack 3 List 1 – Milk and dairy ___ choices per day. See Fluid List later in this guide for milk alternatives. The amount indicated is one choice: Milk / dairy Milk (whole, 2%, 1%, skim) Milk, evaporated Ice cream Amount ½ cup (125 ml) Milk / dairy Soy milk Amount ½ cup (125 ml) ¼ cup (60 ml) ¾ cup (180 ml) Yogurt ½ cup (125 ml) List 2 – Vegetables ___ choices per day. Every vegetable contains potassium. Do not use canned vegetables unless they are salt-free. Use fresh or frozen vegetables. Boiled vegetables are lower in potassium than those cooked in the microwave, steamed, stir fried or roasted (see “presoaking your potatoes” in List 3, next section.) The amount indicated is one choice: Vegetable Asparagus Bean sprouts Broccoli Amount 4 spears ½ cup(125 ml) 1/3 cup (80 ml) boiled Vegetable Beans – green or wax Amount ½ cup (125 ml) boiled Beets Brussels sprouts 1 cup (250 ml) canned (salt-free) 1/3 cup (80 ml) 3 ½ cup (125 ml) raw, chopped Cabbage – red, green, savoy, kale, Bok choy ½ cup (125 ml) frozen, boiled 1 cup (250 ml) raw Carrots ½ cup (125 ml) cooked ½ cup (125 ml) sliced, boiled 1 small raw (5 inch -13 cm) 4 Vegetable Cauliflower Amount 1/3 cup (80 ml) boiled Vegetable Celery ½ cup (125 ml) raw Collard greens Cucumber Endive Lettuce Mushrooms- raw Parsley Peas Radish Spinach – frozen Spinach – fresh ½ cup (125 ml) frozen boiled 1 cup (250 ml) chopped boiled 1 cup (250 ml) slices 1 cup (250 ml) raw 1 cup (250 ml) shredded ½ cup (125 ml) pieces 4 small ½ cup (125 ml) chopped ½ cup (125 ml) fresh or frozen ½ cup (125 ml) canned (SF) 10-15 raw ¼ cup (60 ml) boiled ½ cup (125 ml) chopped Amount 1/3 cup (80 ml) diced 7 inch (18 cm) stalk raw Corn 3 inch (8 cm) cob ½ cup (125 ml) niblets Dandelion greens 1/2 cup (125 ml) boiled Fiddleheads ½ cup (125 ml) boiled Mixed vegetables – ½ cup (125 ml) frozen Onions – raw ½ cup (125 ml) chopped Parsnips Peppers – green, red Salad (tossed) Squash (summer) ¼ cup (60 ml) slices, boiled 1/2 medium raw 1/4 cup (60 ml) cooked ½ cup (125 ml) ¼ cup (60 ml) boiled - Crookneck ½ cup (125 ml) boiled - Scallop ½ cup (125 ml) raw - Zucchini 5 1/3 cup (80 ml) boiled Vegetable Squash – (winter) Amount - Acorn ¼ cup (60 ml) boiled mashed - Butternut ½ cup (125 ml) frozen boiled - Hubbard ¼ cup (60 ml) boiled - Spaghetti Turnip ¾ cup (180 ml) boiled ½ cup (125 ml) boiled Vegetable Tomato – red or green Amount ½ medium Water chestnuts – canned 1 cup (250 ml) slices Potato French fries (frozen) Potato salad – homemade Amount 15 List 3 – Potato ___ choices per day The amount indicated is one choice: Potato Boiled (without skin) Mashed Amount 1 small ½ cup (125 ml) ½ cup (125 ml) Sweet potato - peeled and baked 1 small - peeled, mashed ½ cup (125 ml) If you choose to use raw potatoes in a recipe, you must take away some of the potassium first. Presoaking your potatoes 1.Peel and slice potatoes into small pieces. 2.Soak potatoes in a large amount of water, 10 times the volume of the potatoes, for at least 4-6 hours or overnight. 3.Drain water and use potatoes in your favorite recipe. 6 Potato equivalents If you choose not to have a potato, you can choose one of the following instead: Potato equivalents Tomatoes (saltfree, canned whole) Homemade spaghetti meat sauce Vegetable (see vegetable list) V8 Vegetable Cocktail® – low sodium Amount ½ cup (125 ml) Potato equivalents Amount Tomato sauce 1/3 cup (80 ml) (salt-free) ¾ cup (180 ml) Tomato paste (salt- 3 Tbsp (45 ml) free) 2 choices Fruit (see fruit list) 3 choices ½ cup (125 ml) List 4 - Fruit ___ choices per day Every fruit contains potassium. Fresh, frozen, cooked, and canned fruits may be used. Canned fruit should be drained before serving (the juice contains potassium and is also a fluid). The amount indicated is one choice: Fruit Apple Apricots Amount 1 small 1 medium raw Cherries 3 halves –canned ½ cup (125 ml) raw 8 raw Dates ½ cup (125 ml) canned, sour 2 Blackberries Fruit cocktail ½ cup (125 ml) canned Fruit Applesauce Banana Amount ½ cup (125 ml) 2 inches (5 cm) Blueberries Crab apples 1 cup (250 ml) raw 3 small Figs 1 dried Gooseberries 3 canned 1/3 cup (80 ml) raw 7 Fruit Grapes Lemon or lime Nectarine Passion fruit Amount 14 small 1 medium ½ medium raw 2 medium Fruit Kiwi fruit Mango Orange Peach Amount ½ medium ½ medium raw ½ medium 1 small, fresh 2 halves canned ½ cup (125 ml) fresh or canned Pears ½ medium Pineapple Pomegranate Prunes Raspberries 2 halves canned 1/3 medium 2 dried ½ cup (125 ml) raw Plum Raisins – seedless Rhubarb 1 medium 2 tbsp (30 ml) ½ cup (125 ml) frozen, cooked Tangerine / mandarin 1 small Strawberries Watermelon 1/3 cup (80 ml) frozen ½ cup (125 ml) fresh or frozen ½ cup (125 ml) canned 2/3 cup (160 ml) cubed 1 slice (3 x ¾ inch slice) Remember to drain the juice or syrup off canned fruit. List 5 – Grain products ___ choices per day. Choose grains with less than 10% daily value (DV) sodium, less than 6% DV phosphorus, or less than 12% DV fibre / less than 3 grams if phosphorus is not listed on the label. Check serving size. The amount indicated is one choice. Check the serving size closely on the label, and compare with the serving size in the following chart. Grain Product Amount White bread 1 slice French or Italian bread 1 slice Grain Product Breads Smart bread® (white) Raisin bread 8 Amount 1 slice 1 slice Grain Product Cracked wheat bread Light Rye bread Tortilla wrap – plain Amount 1 slice Grain Product Oatmeal bread Amount 1 slice 1 slice ½ small Pita bread – plain Hamburger bun ½ small ½ bun Wasa Crisp 1 piece breads® Bread sticks – 6 plain Triscuit® 50% less 4 salt Soda crackers – unsalted Rice cakes – unsalted Macaroni, spaghetti – white, cooked Orzo – cooked Arrowroot® Digestive Vanilla wafers Chocolate chip Fig Newton® Sugar cookies Neapolitan wafers Quaker Chewy Granola Bars® Waffle cone – small Popcorn, air popped Crackers Melba toast® 4 pieces 7 6 Ritz® 50% less salt Stoned Wheat Thins® 50% less salt Taco shell 2 Rusk 1 Rice / pasta 1/3 cup (80 ml) Rice – white, cooked ½ cup (125 ml) Cookies 3 2 10 2 1 4 1 ½ cup (125 ml) 3 8 1 Couscous – cooked / snacks Social Tea® Graham Wafers® Animal crackers Chocolate Mallows Apple or Blueberry Newton® Oreo®, Fudge-o® Lady fingers® Ice cream cone 1 Sugar cone– small 1 2 cups (500 ml) 9 ½ cup (125 ml) 4 4 10 3 2 2 2 1 Grain Product Angelfood cake – homemade Sponge cake Doughnut – yeast raised Cream of Wheat® Cornmeal Puffed Wheat Spoon Size Shredded Wheat® Corn Flakes® Special K® Crispix® Multigrain Cheerios® Honey Nut Cheerios® Honey Bunches of Oats® Alpha-Bits® Corn Pops® Froot Loops® Honey Comb® Sugar Crisp® Amount Grain Product Cake 1 slice, 1/16 cake Pound cake Amount 1 slice, 1/16 cake 1 1 slice, 1/16 cake 1/6 pie shell White cake Pie crust Cereal ½ cup (125 ml) Rolled oats / cooked oatmeal ½ cup (125 ml) Puffed Rice cooked ¾ cup (180 ml) Shredded Wheat® ½ cup (125 ml) Mini Wheats® ½ cup (125 ml) 2/3 cup (160 ml) ½ cup (125 ml) ½ cup (125 ml) 1 slice, 1/16 cake ½ cup (125 ml) cooked 2 cups (500 ml) 1 biscuit 14 pieces ½ cup (125 ml) ½ cup (125 ml) ½ cup (125 ml) 3/4 cup (180 ml) ¾ cup (180 ml) Rice Krispies® Life® Cheerios® Apple Cinnamon Cheerios® Oatmeal Crisp® 2/3 cup (160 ml) Harvest Crunch® 1/3 cup (80 ml) ¾ cup (180 ml) 1 cup (250 ml) Captain Crunch® Cinnamon Toast Crunch® Frosted Flakes® Lucky Charms® ½ cup (125 ml) ¾ cup (180 ml) 1 cup (250 ml) 1 cup (250 ml) ¾ cup (180 ml) ½ cup (125 ml) ¾ cup (180 ml) ½ cup (125 ml) ** If you have diabetes, avoid the high sugar foods and pre-sweetened cereals. 10 List 6 – Meat & alternates ___ oz. per day (total) (Cooked weight) Each ounce has approximately 7 grams protein and 60-80 mg phosphorus. Use fresh and fresh frozen meat, fish, and poultry. Foods should be prepared without adding salt, or seasonings that contain salt. Avoid foods that are salted, smoked, cured, dried, processed, or canned with salt. • Meats ›› Beef ›› Rabbit ›› Lamb ›› Veal ›› Pork ›› Venison / game meat ›› Poultry • Fish ›› Bluefish ›› Pollock ›› Catfish ›› Salmon ›› Cod ›› Sea Bass ›› Cusk ›› Shark ›› Flounder ›› Snapper ›› Haddock ›› Sole ›› Mackerel ›› Squid ›› Perch ›› Tuna ›› Pike • Shellfish* ›› Clams (5)=1 oz ›› Scallops (2 large or 4 small)=1 oz ›› Lobster (1 lb lobster)=4 oz fish ›› Shrimp (5 medium)=1 oz ›› Mussels (5)=1 oz • Eggs ›› 1 medium ›› 2 egg whites (low in phosphorus) 11 • Tofu - ½ cup (125 ml) firm = 3 oz • Cheese* ›› Brick ›› Goat (soft plain) ›› Brie ›› Monterey Jack ›› Cheddar ›› Mozzarella ›› Colby ›› Muenster ›› Cottage Cheese - dry curd ¼ cup ›› Ricotta ¼ cup ›› Swiss • Peanut Butter (salt-free): 1 Tbsp=1 oz. meat *These foods should be limited to 2 servings per week. They are high in salt and phosphorus. Guide for measuring meat, fish or poultry Minced meat, fish or poultry - ¼ cup (60 ml) cooked = 1 oz. 3 oz. (90 g) cooked - size of palm of hand, and thickness of meat, fish, or poultry baby finger or the size of a deck of cards List 7 – Fat ___ choices per day Fat Salt-free margarine (non-hydrogenatedtub) Miracle Whip® Low sodium salad dressings Amount 1 tsp (5 ml) Fat Mayonnaise Amount 1 tsp (5 ml) 1 tsp (5 ml) 1 Tbsp (15 ml) Vegetable oils Cream cheese 1 tsp (5 ml) 1 Tbsp (15 ml) 12 Calories It is important that you eat enough calories each day. Eating enough calories helps to prevent the breakdown of protein for energy needs which can cause weight loss. Your dietitian will figure out your calorie needs and advise you about using supplements. **The following foods are low in sodium, potassium, and phosphorus. They can be used to give you extra calories: ›› Brown sugar – 1 Tbsp (15 ml) per day ›› Jujubes, Gum drops ›› Chewing gum ›› Lifesavers®, lollypops, suckers ›› Cool Whip / Cool Whip Light® ›› White sugar, icing sugar ›› Cranberries, cranberry sauce ›› Marshmallows ›› Hard candy, mints ›› Salt-free margarine, vegetable oil ›› Honey, corn syrup ›› Sour cream ›› Jam, jelly, marmalade ›› Whipped cream, Dream Whip® ›› Jelly beans ** If you have diabetes, avoid the high sugar foods 13 Managing fluid intake We need fluid for our bodies to work properly. However, when the kidneys are not working properly, fluid intake must be limited to keep fluid from building up in our bodies. The amount of fluid allowed in your diet depends on the amount of urine (pee) you make. Too much fluid will result in tissue swelling and high blood pressure. The amount of weight gain between dialysis treatments indicates whether you are taking too much fluid - or not. The standard guide is 500 ml or 2 cups plus an amount equal to the previous 24 hour output of urine. Anything that is liquid at room temperature is a fluid (e.g. Popsicles, ice cream, Jell-O®, pudding, soup, ice cubes) **The foods listed below contain limited amounts of phosphorus, sodium, and potassium and may be included in the diet within your fluid allowance. Fluid list ›› Alcoholic spirits - rum, rye, vodka etc. ›› Lemonade, Kool Aid® ›› Liqueurs ›› Almond milk ›› Non-cola pop ›› Canned or bottled cranberry juice or cocktails ›› Rice milk (not enriched) ›› Coffee 1 cup (250 ml) ›› Sherbet ›› Fruit flavored drinks – canned, bottled, crystals, or frozen ›› Popsicles ›› Weak tea (steeped for 3 minutes) ›› Herbal tea ›› Wine (dry white) 3 oz (90 ml) ›› Iced tea ›› Lemon and lime juice If you have diabetes, choose the sugar free version of these foods or avoid them. 14 Tips for managing your fluid intake • Measure the fluid you’re allowed to have every morning in a special pitcher or jug. Every time you eat or drink a fluid, empty that same amount from the pitcher. Once it is empty, that’s all for the day. • Use small cups and glasses for your drinks. • Rinse your mouth with water but do not swallow it (or you can use ice-cold mouthwash). • Brush your teeth more often during the day. • Drink ice-cold liquids because they satisfy better than liquids at room temperature. • Suck on ice cubes or ice chips, but remember, they are part of your daily fluid allowance. (Try using ½ cup (125 ml) of water to make ice cubes at night, then pour off ½ cup (125 ml) of water from your pitcher first thing in the morning.) • Suck on hard candy or mints, or use chewing gum to keep your mouth moist (sugar-free if you have diabetes.) • Try sour candy. • Drink lemonade instead of water or squeeze lemon juice in your ice cubes when you make them. • Stay away from salty foods. Salt makes you thirsty. • If you have diabetes, try to keep blood sugar under control. High blood sugar will make you thirsty. 15 High sodium foods to avoid Snack foods • Salted crackers • Salted party snacks such as: ›› Cheezies ›› Pretzels ›› Chips ›› Salted popcorn - use air popped only ›› Peanuts Quick foods (convenience foods) • Packaged frozen entrées/meals (like microwave dinners) • Packages/boxed foods with more than 10% daily value of sodium per serving • Battered frozen fish or chicken • Bottled or canned spaghetti and pasta sauces • Canned beans, stews, soups, gravies • Canned fish (sardines, kippers, oysters, etc.) ›› Canned tuna and salmon packed in water and rinsed before eating is okay, or use “no salt added” tuna / salmon • Canned meats: ›› Devilled ham ›› KAM®, SPAM®, etc. ›› Flakes of turkey, ham or chicken ›› Potted meats (such as pâtés) • Dry packaged soup mixes, OXO®, bouillon • Fast food items such as fried chicken, Mexican or Chinese food, or pizza Milk products • Blue, feta, parmesan cheeses • Processed cheese (cheese slices, Cheez Whiz®, Velveeta®) 16 Salted, smoked, pickled, or cured meats • Bacon • Bologna, ham, pepperoni, salami, cold cuts • Corned beef • Other deli meats including shaved/sliced turkey and beef as these often have a lot of added sodium • Hot dogs • Kosher meats • Salted, dried, or smoked fish • Sausages Vegetables and fruit • Canned vegetables/fruits with added sodium • Dried fruit • Sauerkraut • Scalloped potato mix, instant potatoes • Vegetable juices (unless labeled low sodium or no salt added) Grain products • Baking mixes such as pancake mixes and biscuit mixes • Breads, cereals, crackers with more than 10% daily value of sodium per serving • Seasoned pasta mixes (Hamburger Helper®, Kraft Dinner®) • Seasoned rice mixes (Rice–a-Roni®, Side Kicks®, Fast and Fancy®) 17 Condiments ›› Accent® ›› Pickles ›› Any mixed spice that has salt ›› Relish ›› Salsa ›› Celery salt ›› Seasoned pepper ›› Chili sauce ›› Seasoned salt ›› Garlic and onion salt ›› Soy sauce ›› Meat tenderizers ›› Steak sauce ›› M.S.G. (monosodium glutamate) ›› Steak spice ›› Taco sauce ›› Picante sauce Foods with higher potassium content (desired blood potassium level: less than 5.5 on hemodialysis) *All fruits and vegetables contain potassium. *Some of these foods can be worked into your diet – ask your dietitian. Fruits highest in potassium: ›› Apricot (raw) ›› Mango ›› Avocado ›› Nectarine ›› Banana ›› Orange, orange juice ›› Cantaloupe ›› Papaya ›› Currants ›› Pomegranate, pomegranate juice ›› Dried fruits (all) ›› Prune juice ›› Grapefruit juice ›› Tamarind ›› Guava ›› Tangelo ›› Honeydew melon ›› Kiwi 18 Vegetables highest in potassium: ›› Artichoke ›› Potato ›› Bamboo shoots ›› Pumpkin ›› Beet greens ›› Spinach ›› Broccoli ›› Squash ›› Brussels sprouts ›› Sweet potato ›› Dandelion greens ›› Swiss chard ›› Lima beans ›› Tomato ›› Parsnips ›› Vegetable juice Other foods higher in potassium: ›› All “bran” cereals ›› Gravy ›› Black strap molasses ›› Low sodium baking powder ›› Brown sugar ›› Milk ›› Chocolate ›› Molasses ›› Coconut ›› Nuts ›› Coconut milk (1/4 cup) ›› Salt substitute (NoSalt®, NuSalt®, HalfSalt®) ›› Dried peas, beans, and lentils ›› Unsalted cheddar cheese ›› French fries ›› Wheat germ 19 High phosphorus foods Phosphorus and calcium are minerals naturally found in your body. When you have normal kidney function, they stay in good balance. When your kidneys don’t work well, phosphorus levels in your blood go up and calcium can go down. To fix this problem, your body will take calcium from bones to “balance” things again. This can cause your bones to become weak and painful, and they could break easily. The calcium binds with phosphorus and can form deposits in your skin, joints, blood vessels and organs. This can cause itching, stiff joints, and problems with other parts of your body, like your heart. Here is how you can help keep your phosphorus and calcium in a healthy balance. 1.Avoid high phosphorus foods. 2.Have a meal or snack when you take your phosphate binders (such as Tums®, calcium carbonate, Renagel®, Fosrenol®, Milk of Magnesia®, PhosLo®). 3.Read food labels – choose grain products with less than 6% Daily Value for phosphorus, or not more than 12% Daily Value of fibre (3 grams of fibre per serving) if phosphorus is not listed on the lable. 4.Follow dietary advice from your dietitian. 20 High phosphorus foods to avoid: • Cake donuts, muffins, biscuits, pancakes, waffles (store bought or mixes) • Chocolate • Dairy products (milk, yogurt, cheese) • Nuts, nut butter, seeds, lentils, dried peas, and beans • Whole grain breads and cereals, such as: natural bran, All-Bran®, Bran Buds®, Bran Flakes®, Oat Bran®, Raisin Bran® • Self-rising flour, baking powder (Your dietitian can help you find a lowphosphorus baking powder) • Organ meats (such as liver or kidney) • Sardines • Canned salmon bones • Processed foods such as: hot dogs, sausage, bologna, pizza • Coca-Cola®, Pepsi®, or other colas, Dr. Pepper® • Beer Phosphate added in processing is 100% absorbed by the body. Phosphate found naturally in foods is 60 – 70 % absorbed by the body. Daily food intake • Milk ___ • Potatoes ___ • Vegetables ___ ___ • Fruit ___ ___ ___ • Grains ___ ___ ___ ___ ___ ___ • Meats ___ ___ ___ ___ ___ ___ • Fat ___ ___ ___ ___ ___ 21 Sample label for grains 1.Start here • Watch serving size 2.Limit sodium • Aim for less than 10% sodium 3.Limit fibre • Aim for less than 3 grams (12%) fibre, if phosphorus is not listed on the label. 4.Limit phosphorus • Aim for less than 6% phosphorus in grains 22 If you have any questions, please ask. We are here to help you. 23 Looking for more health information? Contact your local public library for books, videos, magazine articles, and online health information. For a list of public libraries in Nova Scotia go to www.publiclibraries.ns.ca Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia www.cdha.nshealth.ca Prepared by: Food and Nutrition Services Designed by: Capital Health Library Services, Patient Education Team Printed by: Dalhousie University Print Centre The information in this brochure is provided for informational and educational purposes only. The information is not intended to be and does not constitute healthcare or medical advice. If you have any questions, please ask your healthcare provider. LC85-0628 Revised April 2014 The information in this pamphlet is to be updated every 3 years.