Here's part of what I'm currently working on for renal diets:

NO vs YES, A Guide To Kidney Friendly Foods:

iv INTRODUCTION

The NIH and the USDA are credible sources for nutrient value assays. It’s worth noting, however, that the USDA’s Global Branded Food Products Database includes values for some nutrients in branded and private label foods that appear on product labels which are provided by the food industry data itself.

Some USDA nutrient figures, including but not restricted to those confirmed by the manufacturers, might lead the researcher to conclude that at least a few common dietary recommendations/restrictions for renal patients could be inaccurate, depending on the type and stage of the disease process.

For instance, some kidney diets would have patients avoid tomatoes, green peppers (but not red ones,) pumpkin and other hard-shelled squashes, as well as dried beans, etc.

But a few tomato varieties do NOT contain unreasonable amounts of the minerals CKD patients need to restrict. Values are so low for, say, one small Roma tomato, it barely moves the needle on a 1000 to 1500 mg daily potassium limit recommended for some kidney diets.

Furthermore, green peppers have nearly identical nutrient values to red ones. Green peppers are just that: green, as in not ripe. Red ones are merely ripe green ones with slightly more sugar content due to the ripening. Neither needs to be avoided completely. In fact, the no-no values are so low that bell or sweet peppers can be chopped or sliced in small amounts to be added to almost any savory dish for extra body and flavor.

Pumpkin and all other squashes, especially hard-shelled, are relatively high in potassium. Should they therefore be forbidden? A cup of no-salt added pureed pumpkin is 16 tablespoons. Instead of using an entire cup, one might be able to use 1/4 cup or less safely, depending on permission from one’s renal care team. Smaller amounts still can provide binding in casseroles or baked goods or similar dishes prepared in the microwave and still can offer (albeit smaller amounts of) healthy nutrients without excessive amounts of minerals kidney patients need to restrict. If a renal cook measures carefully and uses maple sugar instead of refined white sugar, egg whites and/or applesauce for less or no actual egg, almond or coconut milk sparingly instead of dairy milk, in small portions a flour/water/healthy oil crust pumpkin pie topped with nondairy “whipped cream” might even be allowable.

Dried and canned shelled beans are high in phosphorus and potassium. Chickpeas are lower in those and 9 pecan halves are even lower. So are green beans.

v INTRODUCTION cont.

Therefore if a person with impaired kidney function craves chili, it’s possible to prepare meatless chili with beans by using an eighth of the amount of kidney beans called for in DIABETIC AND RENAL FRIENDLY VEGETARIAN-ALMOST-VEGAN RECIPES. A small number of chickpeas could account for another eighth, 9 coarsely chopped pecan halves might constitute another eighth, and no salt added green beans could provide the remaining five eighths. By adding half the amount of tomato sauce required and by extending its volume with pureed green (or red) bell pepper then adding the appropriate spices, a person might be able to sit down to a pretty tasty bowl of chili "analog."

Renal patients often are cautioned to limit consumption of potatoes but now some stores are carrying fresh, small potatoes with lower potassium content plus the home cook can peel, soak, and parboil then drain potatoes in order to consume small portions.

And there even are a few processed or ready-to-heat foods appropriate for a renal diet if taken in smaller-than-recommended servings, if eaten only occasionally, and if approved by one’s care team. Flavor and texture often are as important as, if not more important than, the serving amount.

Recommended amounts of nutrients, particularly protein and minerals such as phosphorus, potassium, and sodium, vary according to disease stage and pro-
gression and vary according to whether a person is pre-dialysis or receiving dialysis. Daily values for stages 1-3 CKD pre-dialysis recommended by the NIH are 800 to 1200 mg phosphorus, 1500 to 2700 mg potassium, 2000 to 3000 mg sodium, and 0.36 grams of protein per pound of body weight. Some care providers or experts recommend even less phosphorus, 700 to 800 mg a day, others less protein, as little as 35 grams daily, perhaps lower. The American Heart Association suggests using less sodium, 1500 mg or 1.5 grams a day instead of the common 2-gram daily recommendation.

Cooking sometimes modifies nutritional totals as well. Some USDA food values are for raw ingredients, others are for cooked servings.

Because manufacturers can change ingredients or amounts which then alter valuesfrom what someone previously might have read on product packages, it’s good tocheck labels before each purchase, maybe even to contact the companies.

At present food producers are not required to list phosphorus content on labels and many do not. But while some don’t assay phosphorus, quite a few do

vi INTRODUCTION cont.

know how much an item contains and usually will share that information with the consumer when asked.

It’s wise as well to try to find out how certain ingredients are processed. If a label says the product is vegan and is made with unbleached flour, it may very well be vegan but white flour sometimes is bleached using bone char. One brand of refrigerated pie crust claims to be “vegetable” yet whey from processing cheese is listed on the label and it is not noted as to whether the whey is from dairy milk or formed from yeast and sugar.

A certain kind of tortilla the manufacturer says is vegan contains enzymes which could be either plant or animal derived and the only way to learn which is to
inquire.

Since many renal patients often feel tired, most of the dishes in DIABETIC AND RENAL FRIENDLY VEGETARIAN-ALMOST-VEGAN RECIPES are fairly simple and relatively quick to prepare. Even those requiring a longer time to fix, like home-baked bread or maple bark, offer built-in rest times while the dough rises or the baked goods cook or cool.

Hy-Vee® store brands are among this writer’s preferred recipe ingredients but other brands can be used – check labels and/or contact manufacturers for nutrient values.

NO VS. YES lists nutrient amounts but recipes calling for such ingredients are suggestions only. Patients using this information are free to do so at their own risk and may share at will as long as it's understood that the writer is neither a physician nor a registered dietitian, just a CKD patient who likes to cook.