Key Nutrients in Managing Diabetes-Related Kidney Disease

The Roles They Play and How to Include Them in a Healthy Diet

In This Article

Diet is a key component in managing type 2 diabetes, especially for someone who has developed kidney disease as a result of their condition. This is because when the kidneys aren't functioning normally, excess nutrients, toxins, and fluids can build up in the blood.

It's such a concern most patients with advanced kidney disease are referred to a renal dietitian—a nutrition expert who specializes in kidney disease—in order to devise a personalized eating plan that takes into account specific treatment goals and health status.

It can be tricky to balance good nutrition with dietary restrictions necessary to support kidney health in diabetes. There are a number of vital nutrients that should be restricted but can show up in unexpected foods, for example, and others that come in different forms (such as fats) that should be chosen carefully.

Sodium

Sodium is a vital mineral in the fluids that surround cells. It works in tandem with potassium (see below) to regulate blood pressure and the amount of fluid in the body. It also helps to maintain pH balance and is vital to the proper function of the muscles and nervous system.

Why It Matters in Kidney Disease

When kidneys start to fail, sodium can build up in cells and cause fluid to accumulate in the tissues—swelling that's known as called edema. Edema usually occurs in the face, hands, and lower extremities. Excess sodium also causes blood pressure to rise (hypertension), shortness of breath, and fluid around the heart and lungs, according to the National Kidney Foundation (NKD). Too much sodium in the diet can contribute to damage to the kidneys and exacerbate swelling.

When your kidneys are not healthy, extra sodium and fluid buildup in your body. This can cause swollen ankles, puffiness, a rise in blood pressure, shortness of breath, and/or fluid around your heart and lungs.

Recommended Intake

Most people in the United States consume much more sodium than is recommended—around 3,400 milligrams (mg) per day, according to the U.S. Centers for Disease Control and Prevention (CDC). This is about twice as much as the 2015-2020 Dietary Guidelines for Americans recommends.

People with chronic kidney disease typically are advised to consume even less sodium.

Some health organizations, such as the American Heart Association, recommend people who are 51 and older, are African American, and/or have diabetes, high blood pressure, or CKD lower their sodium intake even more—to 1,500 mg each day.

Sources

Sodium is found in table salt, of course, and so being sparing with the shaker can help lower sodium intake. But sodium also shows up in a wide variety of foods. The NKD estimates that only 10 percent of the salt Americans eat is consumed at home (in cooking and at the table).

The rest comes from store-bought and restaurant foods. If you're on a low-sodium diet to manage diabetes and/or kidney disease, it's essential to know where sodium might be lurking so that you can keep your intake within the levels prescribed by your doctor or nutritionist.

High-sodium Foods
   
Category Foods to Limit/Avoid
Seasonings Celery salt
Garlic salt
Lemon pepper
Lite salt
Meat tenderizer
Onion salt
Seasoning salt
Table salt
Sauces Barbecue sauce
Oyster sauce
Soy sauce
Steak sauce
Teryaki sauce
Snacks Corn chips
Crackers
Nuts
Pretzels
Popcorn
Potato chips
Sunflower seeds
Tortilla chips
Cured Fods Bacon
Ham
Lox and herring
Olives
Pickles and pickle relish
Salt pork
Sauerkraut
Luncheon Meats Cold cuts and deli meats
Corned beef
Hot dogs
Pastrami
Sausage
Spam
Dairy products Buttermilk
Cheese
Canned Foods Canned vegetables
Soups
Tomato products
Vegetable juices
Convenience foods Canned ravioli
Chili
Commercial mixes
Fast foods
Frozen prepared foods
Macaroni and cheese
Spaghetti
TV dinners
Source: The National Kidney Foundation

Potassium

The body needs potassium for almost everything it does, including kidney and heart function, muscle contraction, and the transmission of messages within the nervous system.

Why It Matters in Kidney Disease

Although potassium is important for kidney function, when the diseased kidneys aren't able to filter it out the mineral can build up in the blood—a condition called hyperkalemia. An excess of potassium can be dangerous because it can cause an abnormal heart rhythm, which in turn can become severe enough to cause a heart attack.

If you have kidney disease, your doctor will likely do monthly blood tests to monitor your potassium to make sure it hasn't reached dangerous levels.

NKF Ratings for Potassium Levels

Safe zone: 3.5 to 5.0
Caution zone: 5.1 to 6.0
Danger zone: 6.0 or higher

Recommended Intake

According to the National Institutes of Health (NIH) Office of Dietary Supplements, adult men (19 and over), should get 3,400 mg of potassium daily and adult women should take in 2,600 mg.

Sources

Potassium is found in a wide variety of foods, so it's relatively easy to get ample amounts of it in a regular diet. But because it's not hard to come by, people with diabetes and/or kidney disease whose health could be imperiled by too much potassium should be aware of the richest food sources of the mineral so they can easily limit intake.

Foods With 200 mg of Potassium or More
Food type Specific foods
Fruits Apricots: 2 raw or 5 halves dried
Avocado (1/4 whole)
Banana (1/2 whole)
Cantaloupe
Dates (5)
Dried fruits, including figs, prunes, and raisins
Grapefruit juice
Honeydew melon
Kiwi (1 medium)
Mango (1 medium)
Nectarine (1 medium)
Orange (i medium)
Orange juice
Papay (1/2 whole)
Pomegranate (1 whole)
Pomegranate juice
Prune juice
 
Vegetables Artichoke
Bamboo shoots
Butternut and hubbard squash
Beets (boiled)
Broccoli (cooked)
Brussels sprouts
Chines cabbage
Carrots (raw)
Greens (except kale)
Kohlrabi
White mushrooms
Okra
Parsnips
Potatoes (including sweet)
Pumpkin
Rutabagas
Spinach (cooked)
Tomatoes and tomato products
Vegetable juices
Others Beans (including baked and refried)
Bran
Chocolate 
Granola
Milk (1 cup)
Molasses (1 tablespoon)
Nutritional supplements
Nuts and seeds (1ounce)
Peanut butter (2 tablespoons)
Salt substitute
Salt-free broth
Yogurt
Snuff/chewing tobacco
 
Source: National Kidney Foundation

Phosphorus

Phosphorus is a mineral stored mainly in bones, although smaller amounts are found in teeth, DNA, and cell membranes. It plays a key role in many biochemical reactions: converting food into energy, muscle contraction, nerve conduction, and healthy kidney function. Phosphorus also helps build strong bones.

Why It Matters in Kidney Disease

When healthy and functioning normally, the kidneys filter excess phosphorus out of blood; when the kidneys are diseased, this process is impaired and phosphorus can build up in the body. Excess phosphorus pulls calcium from bones, causing them to weaken.

In addition, high phosphorus and calcium levels may lead to calcium deposits in the lungs, eyes, heart, and blood vessels, which over time can increase the risk of heart attack, stroke, or death.

The tricky thing about phosphorus is that even when blood levels become dangerously high—what's known as hyperphosphatemia—there are no overt symptoms. The condition usually doesn't become evident until stage 4 chronic kidney disease

Recommended Intake

According to the 2015-2020 Dietary Guidelines, adults 19 and over should get 700 mg of phosphorus per day.

Sources

Phosphorus is found in a variety of foods and beverages, in particular:

  • Beer and ale
  • Cocoa and chocolate drinks
  • Dark colas, including Dr. Pepper and similar peppery sodas
  • Canned iced tea
  • Dairy products including milk, milk-based drinks, cheese, custard and pudding, ice cream and cream-based soups
  • Oysters
  • Sardines
  • Fish roe
  • Beef liver, chicken liver, and other organ meats
  • Chocolate candy
  • Caramels
  • Oat bran muffins
  • Brewer's yeast

Phosphorus often is added to fast foods, ready-to-eat foods, canned and bottled drinks, enhanced meats, and most processed foods. To avoid phosphorus additives, look for the letters "phos" on the ingredients list. Some examples:

  • Dicalcium phosphate
  • Disodium phosphate
  • Monosodium phosphate
  • Phosphoric acid
  • Sodium hexametaphosphate
  • Trisodium phosphate
  • Sodium tripolyphosphate
  • Tetrasodium pyrophosphate

Carbohydrates

Carbohydrates are nutrients that serve as the primary source of energy for the body. There are two types:

  • Simple carbs (basically sugars) are used nearly immediately upon consumption or energy
  • Complex carbs (sometimes called starches) are converted into glycogen, which can be stored and used later for energy.

Excess carbohydrates can also be converted to fat.

Why They Matter in Kidney Disease

When kidney disease has resulted from diabetes, managing the latter can play an important role in treating the former. This is because excess levels of sugar (glucose) in the blood is one of the causes of kidney damage due to diabetes.

Recommended Intake

The Dietary Guidelines for Americans advises that about half of daily calories come from carbohydrates, but it's not quite that simple. Complex carbs are healthier than simple ones, for example, and a person's age, weight, height, and activity level also are factors.

For people with diabetes, ideal carbohydrate intake also depends on daily blood glucose levels, particularly for those who take insulin to manage the disease, according to the American Diabetes Association (ADA).

Sources

If you have kidney disease related to diabetes, it's neither necessary nor smart to exclude carbohydrates from your diet altogether. However, you should be extremely picky about the types of carbs you eat. Your doctor or dietitian will provide you with an eating plan that's designed specifically to meet your needs.

However, generally speaking, you'll do best by steering clear of simple carbs and sticking to a prescribed amount of complex carbs. It also may be important that you lower your intake of carbs that are rich sources of potassium and/or phosphorus.

Eat (or Drink) These...

  • Beverages with zero carbos: water, seltzer, unsweetened coffee and iced tea, herbal tea, diet drinks 

  • Beverages low in carbs such as almond milk or soy milk

  • Low-fat and non-fat milk, Greek yogurt, kefir, and cottage cheese 

  • Legumes (beans), peas, squash, pumpkin, sweet potatoes, corn, 100% whole grains (oatmeal, quinoa, barley, etc), non-starchy vegetables

  • Air-popped popcorn, whole grain crackers, whole grain cereals

Not These...

  • Fruit juice, soda, sweetened iced tea and coffee drinks, lemonade, Gatorade, vitamin water, flavored milk 

  • White bread/rolls/bagels, Italian bread, multi-grain bread, white pasta or rice, muffins, croissants, scones, sugary cereals 

  • Crackers, chips, pretzels, sweetened dried fruit, yogurt covered snacks, cookies, cake, ice cream, candy bars, cereal bars

  • Syrup, sugar (all types), honey, agave, molasses, corn syrup, fructose, high fructose corn syrup, sucrose, dextrose, maltose, fruit juice concentrates

Protein

The human body relies on protein for just about everything: Skin, hair, muscles, organs, and hemoglobin are made of protein. The enzymes that break down food and spark chemical reactions are proteins. The immune system depends on protein to make antibodies. Protein molecules aid the transfer of messages between neurotransmitters in the brains. And many hormones, including insulin and other metabolism-regulating hormones, are proteins as well.

Protein molecules are made of smaller molecules called amino acids. There are twenty naturally occurring amino acids. When foods containing protein are eaten, the body breaks them down and reassembles the amino acids to create the protein structures it wants to make.

Why It's Important in Kidney Disease

Damaged kidneys may not be able to remove all of the waste from the protein a person consumes. The more of this waste the kidneys have to deal with, the harder it can be on them, causing dangerous wear-and-tear.

Besides further damage to already-compromised kidneys, a build-up of protein waste can cause symptoms such as nausea, loss of appetite, weakness, and changes in the way things taste.

Recommended Intake

The Recommended Dietary Allowance for protein is 0.8 grams per kilogram of body weight. In easier terms, that comes down to 0.36 grams per pound, which equals as little as 10 percent of daily calories.

To determine how much protein you should take in every day, multiply your weight by 0.36. If you weigh 150 pounds and are relatively sedentary (protein needs are higher for athletes and other physically active people), for example, the ideal amount of protein you should eat is 54 grams.

For people with CKD, research suggests paring back on protein intake can help slow the progression of the disease. However, there are no cookie-cutter guidelines for reducing protein: How much a person should cut back will depend on a variety of individual factors, including whether he or she is on dialysis or not, that a doctor or nutritionist will have to consider.

Sources

Protein can be obtained from animal and from plant sources. Animal proteins have all the essential amino acids, but some sources can be very high in unhealthy (saturated) fats, such as fatty cuts of red meat, whole–milk dairy products, and egg yolks. Fish, poultry, and low–fat or fat–free dairy products have the lowest amounts of saturated fats and are considered better choices for everyone, not just people with CKD or other medical diseases or conditions.

Plant proteins tend to be low in one or more essential amino acids, but by combining certain ones it's possible to consume all the important amino acids when following a plant-based or vegetarian diet. Plants proteins are low in saturated fat and high in fiber as well. Plant sources of protein include beans, lentils, nuts, peanut butter, seeds, and whole grains.

Fat

Healthy fat plays a vital role in overall health. It provides energy, is a building block of membranes throughout the body, carries essential fat-soluble vitamins A, D, E, K, and carotenoids, and helps regulate blood pressure and other heart functions, according to the National Institute of Diabetes and Digestive and Kidney Disease, (NIDDKD).

Why It's Important in Kidney Disease

Certain types of fat are unhealthy: They can raise blood cholesterol and clog blood vessels, increasing the risk of heart attack or stroke in people with CKD who already are more susceptible to these problems than most people.

Recommended Intake

The U.S. Department of Agriculture (USDA) recommends the general population get no more than 30 percent of total calories from fat, and within that parameter, less than 10 percent of fat calories from saturated fat; in addition, the USDA advises limiting cholesterol to less than 300 mg/day.

Sources

Knowing how much fat to include in their diet can be a balancing act for people with chronic kidney disease and the professionals who treat them, one that requires knowing which fats are unhealthy and eliminating them as much as possible while at the same time getting enough healthy fats without taking in excess calories.

Healthy Fats
Type Sources
Monounsaturated Avocado
Canola oil
Nuts like almonds, cashews, pecans, and peanuts
Olive oil and olives
Peanut butter and peanut oil
Sesame seeds
Polyunsaturated Corn oil
Cottonseed oil
Safflower oil
Soybean oil
Sunflower oil
Walnuts
Pumpkin or sunflower seeds
Soft (tub) margarine
Mayonnaise
Salad dressings
Omega-3 Fatty Acids Albacore tuna
Herring
Mackerel
Rainbow trout
Sardines
Salmon
Tofu and other soybean products
Walnuts
Flaxseed and flaxseed oil
Canola oil
Unhealthy Fats
Type Sources
Saturated Fat Lard
Fatback and salt pork
High-fat meats (regular ground beef, ribs, bologna, hot dogs, sausage, bacon)
High-fat dairy products (full-fat cheese, cream, ice cream, whole milk, 2% milk, sour cream
Butter
Cream sauces
Gravy made with meat drippings
Chocolate
Palm oil, palm kernel oil
Coconut, coconut oil
Chicken and turkey skin
Trans Fat Processed foods including crackers and chips and baked goods (muffins, cookies and cakes) with hydrogenated oil or partially hydrogenated oil
Stick margarine
Shortening
Fast foods such as french fries
Cholesterol High-fat dairy products (whole or 2% milk, cream, ice cream, full-fat cheese)
Egg yolks
Liver and other organ meats
High-fat meat and poultry skin
Source: American Diabetes Association
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