Stage 3 Kidney Disease and Diet: What can I eat?

@jeanice, fresh and frozen veggies sound like wonderful choices.

Egg Beaters are egg whites processed with food coloring added and a little pricey. I prefer using free range eggs to Egg Beaters but that's just me.

I bake my own low sodium, low potassium yeast artisan bread and toast a slice for breakfast and spread with vegan spread, made with oil instead of dairy milk.

I also bake my own yeast biscuits (to acoid using baking powder) and make vegan gravy with a tablespoon of flour and 1/3 cup coconut or almond milk (and hot water if it needs to be thinned.) Grapes are good to have with my toast or the occasional mandarin orange. Sometimes I make an omelet or actually fry a whole egg in olive oil. Sometimes I will have ONE HALF of a commercial processed MorningStar Farms veggie sausage patty or a hash brown patty made with leached potatoes (which reduces the potassium.) I limit my intake of potatoes and have no dairy whatsoever but am lactose intolerant.

I also like to make Cherokee corncakes and Chickamauga Skillet Cornbread.

If you tolerate tofu you can "scramble" it with a little chopped celery and green onion.

Kidney patients often are told to avoid tomatoes but a small Roma tomato is fairly low potassium and a good "bang" for the dietary buck but only occasionally.

Herbs and spices are my friends, table salt is not and most of the time I don't miss it.

I love garden salads, too.

I limit beans except green beans and I make my own tortillas so I can have a green bean breakfast burrito - one of my favorites.

There are a lot of breakfast ideas on the Davita site as well as NIKKD and other sites and you don't have to break the bank to obtain ingredients.

I'll be back tomorrow. Meanwhile, happy eating.

Remember, it's taste, not portion size, that matters most.

I have taken a couple of cooking classes at Mayo directed towards patients with CKD. That was very helpful. They gave tips and tricks on what to eat and how to substitute for more kidney friendly foods.

Wonder if Mayo has posted any of their tips and tricks?

@carnes. @jeanice. As I have only recently been diagnosed with kidney disease and diabetes, I would agree with you about how confusing is the information about diets. The two recipes I am sharing with you were born of necessity and have been approved by my doctors and dietitian. I am sharing them with you to help you in your particular situation. I have been eating them every day for six months for breakfast and lunch because I have no choice (I have lost approximately 20 pounds). Prior to developing my two new diseases, I was already limited in my diet choices by Irritable Bowel Syndrome. I hope these recipes help you until you are better able to arrange your own diet choices, but would urge you to check with your doctor/dietitian as to whether they are suitable for you. @kamama94's recipes are wonderful, but I am told I do not at this time have to adhere to such a strict diet. However, when I need to, I will. I do use the information she provides to help plan my dinner menus. You will note that I include dairy, eggs, and fish - I do not adhere to a vegan diet, and based on my research, the dairy, eggs and fish are appropriate for all but the most strict renal diet. The excess liquid from canned products should be drained, but I do not use low sodium tuna, which is usually albacore, because there are other problems with that type of tuna. Cooked chicken would be a good choice to substitute for the fish. I also use a small amount of butter for flavoring the eggs, and again, for me, that's not a problem. A substitute might be EVOO, or mayo, etc.

For breakfast or lunch: Three tablespoons low fat cottage cheese ; one-half cup diced cauliflower rice, onions, bell peppers (red, green or yellow), or radishes; one-half cup chopped fruit - apples, cranberries, grapes, pineapples or strawberries; one-half can (3 oz.) of chunk light tuna in water, sardines, or salmon. Mix and enjoy. Amounts can be increased but start with the minimum. Ingredients can also be mixed, as in peppers and cauliflower. If you are on a vegan diet, not sure what one would substitute for the tuna. Protein is important.

For breakfast or lunch: Two slices bread, toasted; one egg dropped into boiling water and cooked 12 minutes or longer; butter. Toast one slice bread, spread with butter; remove egg, slice off top, and place one-half egg on bread. Egg is enjoyed hot. Toast second slice and repeat. I then eat some sugar snap peas. Please note that I am on a very strict diet, but not a vegan diet. With the eggs, I would suggest choosing fruits and or vegetables (perhaps summer squash or lettuce and tomato) from a recommended list. I limit my serving size to around one-half of a cup and opt to have more variety. After checking the sites @kamama94 suggested, you might be able to make better choices, or ones that are more appetizing. Dinner is my hardest meal of the day as physically I cannot make two separate meals for my husband and myself.

Take your time, and learn all you can. You will find your way, especially with the help of a dietitian. My kidney/diabetes problem arose in the last couple of years, and I am now 80. One has to be tough, I've found, to be a Senior Citizen. Let us know how you are doing, and please be kind to yourself. One suggestion - if you are really hungry between meals or miss desert, two snacks I would recommend - with doctor's approval - are a teaspoon of low-fat peanut butter, perhaps spread on Apple slices, and sugar-free applesauce on toast!!

On the subject of salad dressings, I do not use salad dressings because I can't eat vinegar or citrus. What I do enjoy is a side of rather strong-flavored shredded cheese, such as blue cheese. A tiny quantity, taken with each bite, adds substantial flavor, I think.

@trishanna, great meal plan!

@jeanice, you said your oven isn't working. There are some things you can "bake" in a skillet on top of the stove, especially if you have cast iron cookware. A smaller pan of something also can be baked in a Dutch oven on top of the stove. Ordinarily fried foods aren't necessarily good for you but I personally believe a small amount of olive oil is acceptable for making pancakes or frying other things and at the proper temperature very little oil is absorbed into the food. I microwave most things, micro-steaming or micro-"saute-ing" with plain water. While @trishanna is quite right that the portions and ingredients in my recipe collection are very strict, the cooking techniques still might be helpful. And you always are free to substitute and/or to increase ingredients/serving sizes.

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.

I guess because I'm new at this, it's all so confusing to me. I was a good cook but all these things confuse me. Like Vegan spread. What is that? I am writing alo t so I can remember how to do things. When I see the Kidney Dr.,do you think I'll be out on a different diet being I'm
Stage 3b? For now I think I'll make the salads and Omelets and eat fruit..I needed to loose wiegh but 60 lbs has come off so quick because of being afraid to eat.
What should I expect on first Dr. visit? Do they do blood work to find out where you are? If I'm Stage 4 by then, can I get back to stage 3?
And do you have to have kidney biopsy? I've had burst appendix and other surgeries but that scares me to death! Sorry for all the questions but wish I'd found this site three months ago when I was Stage 1.

@jeanice, vegan spread is like butter only it's dairy free. https://www.smartbalance.com.

If you can go online and google vegan foods and google kidney-friendly foods you can reach various websites with information and many of them encourage you to print their information. There's a list of companies that offer kidney-friendly foods in the recipe collection i sent you - several foods and brands are vegan, several vegetarian, all kidney friendly. If you have a printer, you can download the recipe collection and print it out, it's free and people are encouraged to duplicate it. If you don't have a printer maybe you know someone who can print it out for you.

It's not unheard of to go back and forth between Stage 4 and Stage 3b, it's happened to me twice in 2 years and others have said it's happened to them.

I don't know what the new doctor will do but it's likely that you will have new blood work done to see where you are now. It would be unusual to order a kidney biopsy, at least the first visit, but I'm not saying that one positively would not be ordered, it's just not likely unless your doctor suspects kidney cancer or something similar. Many doctors will order an ultrasound or an MRI to visualize the kidneys first anywway.

Your new doctor may refer you to a dietitian. Don't be afraid to ask for a renal dietitian. If there isn't one in your area there are renal dietitians at many major hospitals and some are online. Some charge a fee, some do not. If there's a dialysis center near you, there might be a renal dietitian on the staff. Mayo Clinics have quite good diet tips and recipes for various stages of kidney illness and you can find these on the Mayo's website. Your doctor may give you a list of foods to limit or avoid or may not but a lot of kidney diet information is relatively easy to find, including in this group.

You've been diagnosed with a serious condition and it's entirely appropriate to be concerned. I know I was. But my doctors and nurses and the good people in this group encouraged me not to panic and reassured me that CKD can be dealt with. Remember that help is available and we are here for you.

Thank you so much. You've been so helpful to me. I got plain yogurt and thought I could put some blueberries or pineapple in with it. Blueberries are my least favorite berry but with diverticulosis can't have seeds or nuts. I'm very careful about that. Did you say you have that too?