Key Nutrients in the Dietary Management of Diabetes and Kidney Disease

Individualized nutrition plans are an important component of the treatment and management of kidney disease. Depending on your kidney function and treatment plan you may need to adhere to certain dietary restrictions.

When your kidneys are not working at full capacity they have a hard time getting rid of extra nutrients, toxins, and fluids that build up in your blood. During this time it is extremely important to follow a good eating plan. 

Most of the time people who have an advanced stage of kidney disease are referred to a renal dietitian - a dietitian that specializes in kidney disease. A proper kidney disease diet takes into account your specific treatment goals and health status.

If you have type 2 diabetes and kidney disease it can become difficult to balance good nutrition when dealing with dietary restrictions, but it is not impossible. There are certain key nutrients that must be taken into consideration: 

Sodium

Although sodium is necessary for your body to function properly, it can build up when kidneys start to fail. Excess sodium in the body can cause fluid to accumulate in the tissues. This is called edema. Edema usually occurs in the face, hands, and lower extremities.

A low-sodium diet is usually the first line of defense when kidney function starts to decrease. Most organizations recommend limiting sodium to 1,500-2,300mg/daily. The best way to reduce sodium in the diet is to cut back on processed foods. Learning how to read labels will help you to cut back on your sodium too.

Limit high sodium foods such as bacon and ham; cold cuts; bottled sauces (soy, barbecue sauce); bouillon cubes; canned, dehydrated or instant soup; canned vegetables; cheese; crackers; salted nuts; olives; pickles; potato chips; processed convenience foods; sauerkraut; and (of course) table salt.

Potassium

Potassium is an important mineral for muscle and heart function. When kidneys can't filter out potassium, too much could be circulating in your blood.

An excess of potassium can be very dangerous because it can cause irregular heart rhythm, which could become severe enough to cause your heart to stop working. Restricting high potassium foods can help prevent this from happening.

Regular blood tests to monitor potassium levels can also alert your doctor to potential problems. Your doctor will let you know if you need to reduce your intake of high potassium foods. If you must restrict your potassium levels, most people need to limit their intake to ~2000mg/daily.

If you are someone who has diabetes and often experiences low blood sugar, you'll want to avoid treating with orange juice and will want to use glucose tablets instead. 

Some high-potassium foods are apricots; baked beans; bananas; beets; broccoli; cantaloupe; chocolate; collard and other greens; molasses; mushrooms; nuts; oranges; peanut butter; potatoes; dried fruit; raisins; salt substitute; and tomatoes.

Hyperphosphatemia (high phosphorus levels in the blood) does not typically become evident until stage 4 chronic kidney disease. When kidneys start to fail, phosphorus can start to build up in your body. This causes an imbalance with calcium, which forces the body to use calcium from the bones. It's important to keep phosphorus levels as close to normal as possible to prevent bones from weakening.

Reducing the amount of high phosphorus foods that you eat is one way to keep phosphorus levels down. Your doctor will let you know if you must reduce your intake. If you must, most people benefit from restricting phosphorus to 800-1000mg/daily.

One of the most important ways to lower your phosphorus levels is to reduce intake of phosphate additives. For example, avoid foods that contain ingredients such as, sodium acid pyrophosphate or monocalcium phosphate. Ask your dietitian or certified diabetes educator for more information. 

Other foods that are rich in phosphorus include beer; bran cereals; caramels; cheese; cocoa; cola; dried beans; ice cream; liver; milk and milk products; nuts; peanut butter; and sardines.

If you have diabetes you are always thinking about monitoring your carbohydrate intake, as this is the food type that impacts blood sugar the most.

If you have diabetes and kidney disease you still want to include carbohydrate sources from vegetables, fruit, and whole grains. You'll also want to avoid added sugars and beverages with high fructose corn syrup and sucrose.

If you are someone with advanced kidney disease you may have to discuss reducing intake of high potassium and high phosphorus sources of carbohydrate with your dietitian. 

Too much protein can be bad for your kidneys if you're living with kidney disease. Discuss your needs with your dietitian as it can vary depending on your treatment plan.

When choosing proteins, aim to include lean sources of protein, such as white meat chicken, fish, turkey, and lean beef. 

The amount of fat you need per day varies from person to person. Focus on incorporating healthy fats into the diet such as oils, and fatty fish and avoid saturated fats and trans fats - processed meats, full-fat cheese, and desserts. 

When kidneys begin to fail, it's time to find a kidney specialist to help you with diet, treatments, and medications. A kidney specialist is called a nephrologist.

With medical guidance and dietary changes, symptoms can be eased, and progression of the disease can be slowed.