Type 2 Diabetes Nutrition & Weight Loss Key Nutrients in Managing Diabetes-Related Kidney Disease The Roles They Play and How to Include Them in a Healthy Diet By Debra Manzella, RN linkedin Debra Manzella, MS, RN, is a corporate clinical educator at Catholic Health System in New York with extensive experience in diabetes care. Learn about our editorial process Debra Manzella, RN Medically reviewed by Medically reviewed by Ana Maria Kausel, MD on September 06, 2020 facebook twitter Ana Maria Kausel, MD, is a double board-certified endocrinologist affiliated with Mount Sinai St. Luke's/Mount Sinai West in New York City. Learn about our Medical Review Board Ana Maria Kausel, MD Updated on October 14, 2020 Print Table of Contents View All Table of Contents Sodium Potassium Phosphorus Carbohydrates Protein Fat Sources 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. Science Photo Library/Getty Images 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. Nephropathy: Kidney Disease and Diabetes 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 more sodium than is recommended—around 3,400 mg per day, according to the Centers for Disease Control and Prevention (CDC). The 2015-2020 Dietary Guidelines for Americans recommends consuming less than 2,300 mg per day. People with chronic kidney disease typically are advised to consume even less sodium. Some health organizations, such as the American Heart Association, recommend most adults move toward an ideal limit of no more than 1,500 mg per 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% 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 5.0Caution zone: 5.1 to 6.0Danger 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. How Carbs Affect Blood Sugar 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). Everything You Should Know About Carbohydrates 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. 4:56 How to Make Herbed Turkey Meat Loaf with Balsamic Brussels Sprouts 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% 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. Following a Vegetarian Diet With Type 2 Diabetes 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 Most people in the general population should consume no more than 25% to 35% of their daily calories from dietary fats, and less than 7% of daily calories should come from saturated fat. Most people should also aim to limit cholesterol intake 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 Was this page helpful? Thanks for your feedback! We know healthy eating is key to help manage diabetes, but that doesn't make it easy. Our free nutrition guide is here to help. Sign up and receive your free copy! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Pizzorno J. The kidney dysfunction epidemic, part 1: causes. Integr Med (Encinitas). 2015;14(6):8-13. National Kidney Foundation. Sodium and your CKD diet: how to spice up your cooking U.S. Centers for Disease Control and Prevention. Get the facts: Sodium and the dietary guidelines. October 2017. American Heart Association. How much sodium should I eat per day? May 23, 2018. American Heart Association. Hyperkalemia (High Potassium). October 31, 2016. National Institute of Health. Potassium fact sheet for health professionals. Updated on July 9, 2019 The Office of Disease Prevention and Health Promotion. Dietary guidelines for Americans 2015-2020 eighth edition American Diabetes Association. Get smart on carb counting Wu G. Dietary protein intake and human health. Food Funct. 2016;7(3):1251-65. doi:10.1039/c5fo01530h González-parra E, Gracia-iguacel C, Egido J, Ortiz A. Phosphorus and nutrition in chronic kidney disease. Int J Nephrol. 2012;2012:597605. DOI: 10.1155/2012/597605 National Heart, Lung and Blood Institute. How to lower cholesterol with diet. February 27, 2019. Additional Reading American Diabetic Association. Carbohydrate counting. Aug 30,2017. National Institute of Diabetes and Digestive and Kidney Diseases. Nutrition for advanced chronic kidney disease in adults. Mar 2014.