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

@carnes
I found a "Diabetes meal plan recipes" in Mayo's Patient Care and Health Information Section. You can find a list of some Healthy Recipes that might give you some ideas. I hope you will find something that will satisfy your tastes as well as your dietary needs.
https://www.mayoclinic.org/healthy-lifestyle/recipes/diabetes-meal-plan-recipes/rcs-20077150
I am not on a diabetic diet. However, I am always interested in something to perk up my meals. So, I want to ask you to share a new recipe that you discover. OK?

After CKD diagnosis about 5 years ago my nephrologist suggested a vegetarian diet. I actually went "almost vegan" because I stopped eating meat of any kind and being sensitive to dairy I eliminated most dairy except for small amounts of "cooked" dairy milk in some breads and certain other products. (For me trying to avoid using animal products any more was as much a personal ethical decision as a health choice but I did and still do have free-range eggs.) My CKD improved.

But after a bout of shingles over two years ago, kidney function dropped dramatically and I was on dialysis for a short time then gradually recovered enough to move from stage five back to stage four and stop dialysis.

Recently, though, I developed gastroparesis, the diet for which conflicts with a renal diet and a diabetic diet, so I've had to pick and choose and modify and compromise with all 3 diets - quite a challenge and much less than ideal.

Here are my daily nutritional parameters, to which I cannot always adhere, depending on gastric issues and varying absorption rates: 1000-1200 calories, 700-800 mg phosphorus, 1800-2400 mg potassium, 1500-1700 mg sodium, 33-36 Gm protein, 150-260 Gm carbohydrates, 10-15 Gm fiber, 22-50 Gm fat, 8 mg iron. (I've read on various websites several months ago that the new sodium recommendation is 1000 mg daily, especially for stage 4 CKD.)

I have found that many vegan dishes such as highly processed vegan bowls or processed meat analogs contain too much sodium and too much protein for my remaining kidney to deal with and I have to limit soy as well.

I also found I could not afford many "basic" vegan ingredients to make my own burger patties, for instance (as well as other vegan foods.) Then, too, the vegetables comprising home-made veggie burgers have too much potassium per serving for a compromised kidney to process.

I have had to resort to ready-to-cook commercially prepared meat analogs for the protein but have half or even a fourth of a serving and so far kidney function is relatively stable at 27 to 30 eGFR and creatinine is less high.

However, since I've added Miralax to my medications for gastroparesis and acidophilus lactobacillus along with resorting to processed meat analogs, I've noticed edema across the tops of my feet (not much in the mornings but increased to marked "puffiness" by evening - docs are aware and we are monitoring this.) Although my labs show acceptable serum sodium levels I know I am taking close to 1500 mg Na daily (sometimes a little more,) instead of the recommended 1000 for stage 4 CKD. I'm watching closely for increased edema and have tried to reduce sodium intake the best I can but if it gets worse I may have to back off some of the higher sodium foods with the unfortunate consequence of increased anemia and decreased stamina and energy and more weight loss. (Since hospitalization and a gastroparesis diagnosis then going on a gastroparesis diet over a year ago I've lost 80 pounds.)

I welcome comments and suggestions.

I’m sorry to hear of your struggles. It’s a lot to grapple with but sounds like you are figuring it out. I’ve read on several Kidney nutrition sites that legumes, because they are plants, potassium and phosphorous amounts are not readily absorbed, making the numbers misleading. There is a good article regarding this from Kidney Community Kitchen and another one from “Emily kidney nutrition” blog. Emily Campbell is a registered renal Dietician and The article is titled “How to include beans in your CKD diet. “ 😊I printed out so much info but will try to find these in my online files to attach.

After CKD diagnosis about 5 years ago my nephrologist suggested a vegetarian diet. I actually went "almost vegan" because I stopped eating meat of any kind and being sensitive to dairy I eliminated most dairy except for small amounts of "cooked" dairy milk in some breads and certain other products. (For me trying to avoid using animal products any more was as much a personal ethical decision as a health choice but I did and still do have free-range eggs.) My CKD improved.

But after a bout of shingles over two years ago, kidney function dropped dramatically and I was on dialysis for a short time then gradually recovered enough to move from stage five back to stage four and stop dialysis.

Recently, though, I developed gastroparesis, the diet for which conflicts with a renal diet and a diabetic diet, so I've had to pick and choose and modify and compromise with all 3 diets - quite a challenge and much less than ideal.

Here are my daily nutritional parameters, to which I cannot always adhere, depending on gastric issues and varying absorption rates: 1000-1200 calories, 700-800 mg phosphorus, 1800-2400 mg potassium, 1500-1700 mg sodium, 33-36 Gm protein, 150-260 Gm carbohydrates, 10-15 Gm fiber, 22-50 Gm fat, 8 mg iron. (I've read on various websites several months ago that the new sodium recommendation is 1000 mg daily, especially for stage 4 CKD.)

I have found that many vegan dishes such as highly processed vegan bowls or processed meat analogs contain too much sodium and too much protein for my remaining kidney to deal with and I have to limit soy as well.

I also found I could not afford many "basic" vegan ingredients to make my own burger patties, for instance (as well as other vegan foods.) Then, too, the vegetables comprising home-made veggie burgers have too much potassium per serving for a compromised kidney to process.

I have had to resort to ready-to-cook commercially prepared meat analogs for the protein but have half or even a fourth of a serving and so far kidney function is relatively stable at 27 to 30 eGFR and creatinine is less high.

However, since I've added Miralax to my medications for gastroparesis and acidophilus lactobacillus along with resorting to processed meat analogs, I've noticed edema across the tops of my feet (not much in the mornings but increased to marked "puffiness" by evening - docs are aware and we are monitoring this.) Although my labs show acceptable serum sodium levels I know I am taking close to 1500 mg Na daily (sometimes a little more,) instead of the recommended 1000 for stage 4 CKD. I'm watching closely for increased edema and have tried to reduce sodium intake the best I can but if it gets worse I may have to back off some of the higher sodium foods with the unfortunate consequence of increased anemia and decreased stamina and energy and more weight loss. (Since hospitalization and a gastroparesis diagnosis then going on a gastroparesis diet over a year ago I've lost 80 pounds.)

I welcome comments and suggestions.

@kamama94 Are you able to take a diuretic that would decrease fluid retention, along with the lowered sodium you are doing?

I also use Miralax as needed, per my dialysis clinic. It sounds to me it is such a balancing act for you, much more than the daily one I struggle with! There has to be some give-and-take, right? You certainly have my blessings, and encouragement!
Ginger

@kamama94
@gingerw
My journey with both CKD & type 2 Diabetes has taken a different approach over the last 2 months in such a way that I no longer take diabetic medication. I am now working with a former PA nephrologist who now is involved in functional medicine. She introduced me to Dr. Jason Fung , a nephrologist, who follows the approach of intermittent fasting. He has written, among others, The Obesity Code & The Diabetes Code. He claims that following a form of fasting, whether it be for 6 hours or longer, that our habits of eating can change without going through hunger stages. This has helped me immensely get off two types of insulin for diabetes, and stay in control with my dietitian. So following Libre 2, I am able to stay in the good zone range 95% of the time. My converted A1C is now about 6.3 where I struggled to get less than 7, but could not do it over the last few years. You can watch Jason Fung videos on YouTube. The idea behind this is we are so accustomed to eating 3 square meals a day, our habits cannot change, but it can. My go to snack is Costco celery sticks with Costco organic peanut butter, once or twice a day.

I now take supplements COQ10 & Resvertrol to give me energy throughout the day. Fortunately, I have never had heart problems so my blood pressure has always been consistently good. I have also increased my Ozempic from 1MG to 2MG, the Wegovy dose of once per week. I also take Miralax twice a day with Benefiber mixed in once with 60 ounces of lemon water per day. I use the powdered form of lemon called True Lemon. If you are taking statin drugs, try to reduce or eliminate them, but obviously follow doctor's orders.

Unfortunately, I cannot take diuretic medications like Farxiga or Torsemide as I get dehydrated quickly and do not enjoy going to the bathroom 6 times during the night and reduced eGFR.

For all of us, this is a journey. I wish I was as diligent as @kamama94 for following her nutritional parameters, but have a plan with my Mayo dietitian, Dr. Jason Fung, and my former PA nephrologist. My weekly visits to my acupuncturist with a Ph.D in Immunology helps tremendously.

@collegeprof, thanks for your response and the info.

My neph told me about Dr. Fung and I've seen his videos.

However, I already do an intermittent fast but it's miserable because it's triggered by gastroparesis and I can't eat anything for hours, sometimes it goes on for days and I have to decrease or withhold insulin and add Boost and juices in order to keep from becoming so week I have to go to the hospital in an ambulance as happened to me this past February (again!)

A purgative given at the hospital got things moving again and IV fluids helped with the weakness and they sent me home the 2nd evening. Since then I've felt much better and am eating better and have much more energy. Blood sugars are much lower and we've had to titrate my insulin to 1 unit per 7 grams carbs and sometimes I have to skip the insulin altogether.

Docs and I have discussed the fact that with GP, absorption sometimes is fast getting glucose to the bloodstream and sometimes quite slow so I must monitor blood sugars closely and be alert to paresis symptoms to try to reverse it before it gets to the point of needing an ambulance.

I walk a daily tightrope because of these and many other comorbidities and when I do have to fast, it isn't by choice.

I'm so glad your diabetes has improved! Congrats on getting that A1C down. Keep up the good work and please stay in touch, I appreciate your posts and your feedback so thanks again!

@kamama94

My go to medication when I took insulin was glucose tablets rather than juices and candy as they have a habit going to the other extreme, like a yo yo with blood sugar. I still continue with monitoring my blood glucose with the Libre 2. I have found that the glucose tablets bring my blood sugar to normalcy instead of the yo yo effect. The weakness you feel may be able to be compensated by the energy supplements of COQ10 & Resvertrol. You may wish to talk to your doc about this. If there is anyone in this world who can talk about nutrition and CKD, you are that source.