What Does A Therapeutic Renal Disease Diet Entail?

We’ve always been huge proponents of diet’s effect on mitigating kidney function loss and keeping kidney health as strongly supported as possible. This doesn’t mean following a renal disease diet is easy. Quite the contrary, when first being diagnosed, many kidney sufferers are discouraged and confused by the sudden limitations on their diets. It can be challenging and overwhelming, but is also one of the most vital and scientifically-proven methods of extending your kidney’s function.

Knowing Which Diet Is Right For You

Of the numerous diets which have been researched for specific types of kidney diseases, there are three in particular which are the gold standard in what is recommended:

Low to Very Low Protein Diet Supplemented with Essential Amino Acids
Vegetarian Diet For Kidney Disease
Academy of Nutrition and Dietetics Kidney Disease Diet

There are a few factors which will contribute to which diet would be the best for you to follow, typically these are which stage you are currently at as well as which diet is going to be the easiest for you to stick with. There’s also another option. You can (again, depending on stage) incorporate a blend of the three that suits your situation.

The Different Aspects of a Therapeutic Renal Diet

Low Phosphorus
Phosphorus is another important mineral that the kidneys need to keep regulated. In kidney disease, phosphorus levels can become elevated leading to complications with the skeletal system (bones), the body’s energy production, and cell functioning. High levels also put more stress on the kidneys, forcing them to work harder which leads to a faster decline in function. Luckily, most absorbable phosphorus is contained in protein rich foods.In a recent study published by the Medical Dialogues, August 2020, researchers have reported that kidney sufferers on hemodialysis received a modified low-phosphorus diet and showed alike phosphate levels as those who were on a standard diet. The modified diet had more options and a higher fiber content. Phosphorus works with calcium to build strong bones and maintain other parts of your body healthy. Foods such as milk and cheese, dried beans, colas, canned iced teas and lemonade, nuts, and peanut butter are high in phosphorus. When your kidneys can no longer keep your phosphorus at the right level, it builds up. At this point, phosphorus becomes harmful to your body.Healthy kidneys can easily get rid of extra phosphorus in the blood. However, with chronic kidney disease (CKD), your kidneys may underperform and have trouble in removing phosphorus. High levels of phosphorus causes body changes that pull calcium out of your bones, making them weak. Hyperphosphatemia is common is end-stage renal disease (ESRD) and overtime can lead to deadly calcium deposits in blood vessels, lungs, eyes, and heart. Cutting back on high-phosphorus foods and taking calcimimetic medications can gradually help treat hyperphosphatemia.

In the study performed, researchers’ main motive was to understand if a modified low phosphorus diet could promote reducing serum phosphate levels in hemodialysis individuals. They also took into account other subjects like hyperkalemia, nutritional composition, and the fiber content of the modified diet. The study entailed two groups on two different diets; modified low-phosphorus diet vs. standard diet. 74 adults on hemodialysis with high phosphorus levels were observed over a period of one month. Individuals were directed to exchange 2 animal-based proteins for 2 plant-based proteins. What the researchers found out at the end of the study were some positive outcomes of a modified low phosphorus diet. At the end of the course, they found no change in serum phosphate levels among the standard and modified diet. The modified low phosphorus diet showed a higher ‘phytate bound phosphate’ content than the standard diet. Both diets were closely kidney-friendly but the modified low phosphorus diet also had a higher fiber intake.

We know that consuming high amounts with kidney issues can put tremendous stress on your kidneys. With CKD, your kidneys have a hard time removing phosphorus from your blood and high phosphorus levels can eventually damage your kidneys, additionally, pulling calcium out of your bones, making them weak. The study concluded that with the intake of phytate bound phosphorus being higher in the modified diet, the kidney disease sufferers were introduced to broaden their diet choices without any side effects.
Low to Moderate Potassium
Potassium is one of the main minerals of the body. It plays a critical role in heart functioning through muscular contraction. The kidneys are responsible for excreting 90% of the potassium from the body. In diabetic kidney disease, there may be either too little potassium or too much (too much is known as hyperkalemia). It’s much more common to have hyperkalemia in kidney disease.Hyperkalemia can lead to dysrhythmias (irregular heartbeats) and cardiac arrest. This along with high potassium levels may cause further damage to the kidneys. This is why a low to moderate potassium diet is being suggested.
You may think why not consume a low potassium diet? In order to maintain low protein consumption — the most important part — you have to consume moderate amounts of potassium foods to maintain good nutritional status.
Low Sodium
Sodium is essential for many body functions including regulating the blood pressure and blood volume, helping transmit impulses for nerve function, muscle contractions and regulating the acid-alkaline (aka acid-base) balance of blood and body fluids.When kidney disease is present, extra sodium can build up in the body leading to fluid accumulation. This can cause swollen ankles, puffiness, a rise in blood pressure, shortness of breath, and/or fluid around your heart and lungs which can lead to heart failure. Keeping sodium levels low is important to maintaining overall health with kidney disease. Salt should never be added to foods. Don’t purchase food with high amounts of salt. Ideally, sodium intake should not exceed 2000mg per day. Its best to stay at 1500mg or less per day.
Higher Alkaline
The kidneys maintain the acid-alkaline balance of the body (Ph level). When too much acid builds up in the body from acidic foods and the kidneys cannot keep the balance, the results are inflammation, chronic illness and worsening of kidney function.This is why a higher alkaline diet is preferred. Every food is either considered alkaline or acidic, and maintaining a higher amount of alkaline foods will help take the stress off your kidneys. Fresh fruits and vegetables like cauliflower, lettuce, onions, peas, peppers, apples, berries, grapes and lemons are quick and effective ways to incorporate more alkaline foods into your diet.
High Fiber
A high fiber diet of 20 to 35 grams per day from food and supplements has shown to slow and improve kidney disease. Fiber has anti-inflammatory benefits and clears toxins out of the gastrointestinal tract, which build up in kidney disease. In order to achieve a high fiber diet without the additional potassium from fruits and vegetables, a supplement may be introduced.
Vegetarian
Why vegetarian? All animal sources of food (dairy, eggs, chicken, meats including beef, lamb, goat, etc.) have been shown to decrease kidney function once there is damage. The reason is that after digestion of animal proteins, more urea and toxins need to be filtered by your kidneys. Vegetarian food sources have been shown to delay kidney function and nutrients like phosphorus aren’t easily absorbed from vegetarian sources of food.
Anti-Inflammatory & Anti-Oxidant
This diet will have many healthy, good anti-inflammatory fats and other foods, which have been shown to help kidney disease. For example, sesame oil has been shown to help protect and help injured kidneys recover because of the anti-inflammatory and anti-oxidant benefits and ability to help control the body’s glucose level. Glucose level is the amount of glucose (aka “sugar or blood sugar”) within the body. When the body’s glucose remains high, this can lead to further kidney damage.Anti-inflammatory and anti-oxidant foods are important for those major reasons. Many fruits in the berry family, such as strawberries, blueberries and cherries, have been shown to significantly reduce inflammation, along with being renowned for their anti-oxidant properties. Another great anti-inflammatory agent is olive oil, so be sure to use it in your foods whenever you can. And, in addition to its kidney-boosting ability, it should come as no surprise that green tea is another rich source of anti-inflammatory/anti-oxidant properties.
Low Protein
Since protein is one of the levels kidney sufferers need to be most mindful of, this diet is particularly useful for those dealing with excess proteinuria. Adopting a low or very low protein diet along with low phosphorus, low to moderate potassium, low sodium, higher alkaline and high fiber can help slow kidney decline.

The Low Protein Diet Introduction
The “base” of this low to very low protein diet with supplemental amino acids, has been used for the last 35 years with great success in the Czech Republic, Hungary, Brazil, Italy, Mexico, China, France, Mideast, etc. It became popularized in the United States from a book called “Coping with Kidney Disease: A 12-Step Treatment Program to Help You Avoid Dialysis,” by Mackenzie Walser MD & Betsy Thorpe.

It’s commonly known that regular protein intake results in a faster rate of declining kidney function in those suffering from CKD. Protein consumption can often lead to an accumulation of nitrogen waste products, urea, hydrogen ions, phosphates, and inorganic ions which have to be eliminated or regulated by the kidney. Dietary protein lost during kidney disease (proteinuria) also leads to kidney-damaging inflammation.

In Summary

Frozen, Fresh and Canned Foods
It is best to use fresh or frozen foods because of the lower salt content of fresh foods and, in most cases, lower potassium content of frozen foods compared to canned foods. Typically, the higher sodium content of frozen and canned foods, and the added sugar often makes them undesirable. If you can, find frozen and canned foods without salt and added sugar.
Proteins
Opt for veggie-substitute meats or tofu, tempeh, beans, nuts, etc. Infrequent consumption of lean poultry or salmon is acceptable if your own protein levels are at a safe range.
Fats and Oils
Sesame seed oil, flax seed oil, canola oil, coconut oil, extra virgin olive oil and walnut oil. Butter is neutral, but should be consumed infrequently.
Vinegars, Salt, Seasonings and Condiments
All vinegars are acceptable with kidney disease; make sure no salt is added. Be especially sure to avoid table salt and any seasonings that have the word “salt or sodium,” avoid salt substitutes (they contain potassium) and any seasonings with potassium. Purchase the lowest sodium foods you can and don’t add salt to any foods. Most other seasonings are acceptable. Keep sodium intake to 1500-2000mg per day.
- List of Seasonings and Condiments
  Allspice, basil, bay leaf, caraway seed, chives, cilantro, cinnamon, cloves, cumin, curry, dill, extracts (almond, lemon, lime, maple, orange, peppermint, vanilla, walnut), fennel, garlic powder, ginger, horseradish (root), lemon juice, low sodium hot sauce like Tabasco®, mustard, Mrs. Dash®, nutmeg, onion powder or flakes, oregano, paprika, parsley flakes, pepper (ground), pimentos, poppy seed, rosemary, saffron, sage, savory, sesame seeds, tarragon, thyme, turmeric, vegan mayo (not made with soy, check protein content).
- Salad Dressings
  It is best to make your own with oil, vinegar, spices and, vegan mayo. Some Russian, French, and Ranch dressings have low potassium and protein levels and can be consumed.
Jelly, Jams and Honey/Sweeteners
These are simple sugars that contain only small amounts of potassium, sodium or phosphorus when used in the amounts listed to consume. You can have between two to five tablespoons per day. It is best to stay to near two tablespoons and look for the least amount of sugar when purchasing jams and jellies. For sweeteners, opt for Stevia.
Beverages
Water, Green Tea, Hibiscus Tea, Chamomile, Black Tea, Rice Milk, Almond Milk.
Fruits
Apples, Blackberries, Blueberries, Cherries, Cranberries, Grapes, Lemon, Lime, Pineapple, Plums, Raspberries, Strawberries, Tangerines.
Vegetables
Alfalfa, asparagus, bean sprouts, cabbage, corn, cauliflower, green beans, eggplant, jicama, leeks, lettuce, mushrooms (shiitake), onions, green peas, chili peppers, scallions, radicchio, radishes.
Breads/Cereals/Grains
Whole grains have higher amounts of phosphorus and potassium and should be avoided or limited in the later stages of kidney disease. Wheat flour, bagels, bread sticks, bulgur wheat, couscous, wheat crackers, croissants, dinner/hard rolls, english muffins, french bread, italian bread, light rye, melba toast, noodles, oyster crackers, pancakes, pasta, pita, soft wheat, tortillas, waffles, white/wheat bread, corn flour/meal, corn and rice varieties of all aforementioned.

The Vegetarian Diet for Kidney Disease Introduction

A vegetarian, plant based, diet has shown to slow down or stop renal disease from progressing. It can also prevent problems that often arise in renal disease such as high blood pressure, high cholesterol, inflammation, digestive issues, etc.

In a vegetarian diet the amino acids that make up plant based proteins, as opposed to animal proteins, create less stress on the kidneys, improving kidney health. Vegetarian foods create less pressure on the kidney and allow better glucose control, improving diabetes, and decreasing proteinuria.

Most vegetarians fall into one of the following categories:

Lacto-vegetarians
This group excludes eggs, but consumes milk and other dairy products in addition to plant foods.
Lacto-ovo vegetarians
This group consumes eggs, milk, dairy products and plant foods.
Pesco-vegetarians
This group eats fish for health reasons, in addition to eating plant foods, dairy products and eggs.
Vegan
This group consumes only plant foods and no animal products.

This Vegetarian Diet for Renal Disease is much like the low protein diet only it has a more vegan slant to it. It also comprises plant based protein along with low to moderate phosphorus intake, low to moderate potassium, low sodium, higher alkaline, and is a high fiber diet.

In Summary

Frozen, Fresh and Canned Foods
It is best to use fresh or frozen foods because of the lower salt content of fresh foods and, in most cases, lower potassium content of frozen foods compared to canned foods. Typically, the higher sodium content of frozen and canned foods, and the added sugar often makes them undesirable. If you can, find frozen and canned foods without salt and added sugar.
Proteins
Opt for veggie-substitute meats or tofu, tempeh, beans, nuts, etc.
Fats and Oils
Sesame seed oil, flax seed oil, canola oil, coconut oil, extra virgin olive oil and walnut oil. Butter is neutral, but should be consumed infrequently.
Vinegars, Salt, Seasonings and Condiments
All vinegars are acceptable with kidney disease; make sure no salt is added. Be especially sure to avoid table salt and any seasonings that have the word “salt or sodium,” avoid salt substitutes (they contain potassium) and any seasonings with potassium. Purchase the lowest sodium foods you can and don’t add salt to any foods. Most other seasonings are acceptable. Keep sodium intake to 1500-2000mg per day.
- List of Seasonings and Condiments
  Allspice, basil, bay leaf, caraway seed, chives, cilantro, cinnamon, cloves, cumin, curry, dill, extracts (almond, lemon, lime, maple, orange, peppermint, vanilla, walnut), fennel, garlic powder, ginger, horseradish (root), lemon juice, low sodium hot sauce like Tabasco®, mustard, Mrs. Dash®, nutmeg, onion powder or flakes, oregano, paprika, parsley flakes, pepper (ground), pimentos, poppy seed, rosemary, saffron, sage, savory, sesame seeds, tarragon, thyme, turmeric, vegan mayo (not made with soy, check protein content).
- Salad Dressings
  It is best to make your own with oil, vinegar, spices and, vegan mayo. Some Russian, French, and Ranch dressings have low potassium and protein levels and can be consumed.
Jelly, Jams and Honey/Sweeteners
These are simple sugars that contain only small amounts of potassium, sodium or phosphorus when used in the amounts listed to consume. You can have between two to five tablespoons per day. It is best to stay to near two tablespoons and look for the least amount of sugar when purchasing jams and jellies. For sweeteners, opt for Stevia.
Beverages
Water, Green Tea, Hibiscus Tea, Chamomile, Black Tea, Rice Milk, Almond Milk.
Fruits
Apples, Blackberries, Blueberries, Cherries, Cranberries, Grapes, Lemon, Lime, Pineapple, Plums, Raspberries, Strawberries, Tangerines.
Vegetables
Alfalfa, asparagus, bean sprouts, cabbage, corn, cauliflower, green beans, eggplant, jicama, leeks, lettuce, mushrooms (shiitake), onions, green peas, chili peppers, scallions, radicchio, radishes.
Breads/Cereals/Grains
Whole grains have higher amounts of phosphorus and potassium and should be avoided or limited in the later stages of kidney disease. Wheat flour, bagels, bread sticks, bulgur wheat, couscous, wheat crackers, croissants, dinner/hard rolls, english muffins, french bread, italian bread, light rye, melba toast, noodles, oyster crackers, pancakes, pasta, pita, soft wheat, tortillas, waffles, white/wheat bread, corn flour/meal, corn and rice varieties of all aforementioned.

The Academy of Nutrition and Dietetics Diet

The Academy of Nutrition and Dietetics is an organization of food and nutrition professionals founded in Cleveland, Ohio, in 1917, by a group of women dedicated to helping the government conserve food and improve the public’s health and nutrition during World War I.

Today, the Academy credentializes practitioners as registered dietitians, dietetic technicians and other dietetics professionals holding undergraduate and advanced degrees; Dietetic practitioners work in health care systems, home health care, food service, business, research and educational organizations, as well as in private practice. Community-based dietetic practitioners provide health promotion, disease prevention and wellness services.

The major difference of dietitians and other nutrition professionals is they follow the recommendations set forth by the Academy. The Dietetic approach to dealing with Chronic Kidney Disease is centered around achieving optimal balance of protein, sodium and potassium, doing so through the foods that you eat. It has more of a focus on animal products, as opposed to the low protein and vegetarian diet.

In Summary

Frozen, Fresh and Canned Foods
It is best to use fresh or frozen foods because of the lower salt content of fresh foods and, in most cases, lower potassium content of frozen foods compared to canned foods. Typically, the higher sodium content of frozen and canned foods, and the added sugar often makes them undesirable. If you can, find frozen and canned foods without salt and added sugar.
Proteins
Consumption of lean poultry, salmon, turkey bacon, lean cuts of pork and beef are acceptable if your own protein levels are at a safe range.
Fats and Oils
Sesame seed oil, flax seed oil, canola oil, coconut oil, extra virgin olive oil and walnut oil. Butter is neutral, but should be consumed infrequently.
Vinegars, Salt, Seasonings and Condiments
All vinegars are acceptable with kidney disease; make sure no salt is added. Be especially sure to avoid table salt and any seasonings that have the word “salt or sodium,” avoid salt substitutes (they contain potassium) and any seasonings with potassium. Purchase the lowest sodium foods you can and don’t add salt to any foods. Most other seasonings are acceptable. Keep sodium intake to 1500-2000mg per day.
- List of Seasonings and Condiments
  Allspice, basil, bay leaf, caraway seed, chives, cilantro, cinnamon, cloves, cumin, curry, dill, extracts (almond, lemon, lime, maple, orange, peppermint, vanilla, walnut), fennel, garlic powder, ginger, horseradish (root), lemon juice, low sodium hot sauce like Tabasco®, mustard, Mrs. Dash®, nutmeg, onion powder or flakes, oregano, paprika, parsley flakes, pepper (ground), pimentos, poppy seed, rosemary, saffron, sage, savory, sesame seeds, tarragon, thyme, turmeric, vegan mayo (not made with soy, check protein content).
- Salad Dressings
  It is best to make your own with oil, vinegar, spices and, vegan mayo. Some Russian, French, and Ranch dressings have low potassium and protein levels and can be consumed.
Jelly, Jams and Honey/Sweeteners
These are simple sugars that contain only small amounts of potassium, sodium or phosphorus when used in the amounts listed to consume. You can have between two to five tablespoons per day. It is best to stay to near two tablespoons and look for the least amount of sugar when purchasing jams and jellies. For sweeteners, opt for Stevia.
Beverages
Water, Green Tea, Hibiscus Tea, Chamomile, Black Tea, Rice Milk, Almond Milk.
Fruits
Apples, Blackberries, Blueberries, Cherries, Cranberries, Grapes, Lemon, Lime, Pineapple, Plums, Raspberries, Strawberries, Tangerines.
Vegetables
Alfalfa, asparagus, bean sprouts, cabbage, corn, cauliflower, green beans, eggplant, jicama, leeks, lettuce, mushrooms (shiitake), onions, green peas, chili peppers, scallions, radicchio, radishes.
Breads/Cereals/Grains
Whole grains have higher amounts of phosphorus and potassium and should be avoided or limited in the later stages of kidney disease. Wheat flour, bagels, bread sticks, bulgur wheat, couscous, wheat crackers, croissants, dinner/hard rolls, english muffins, french bread, italian bread, light rye, melba toast, noodles, oyster crackers, pancakes, pasta, pita, soft wheat, tortillas, waffles, white/wheat bread, corn flour/meal, corn and rice varieties of all aforementioned.

Here is an example of what the suggested portion size of the Academy’s diet plan is like:

Foods To Avoid
Now that we’ve highlighted the three major diets (this, keep in mind, is just a cursory preview and if you are interested in learning more about any of the diets mentioned, we advise you to order our All-Natural Kidney Program which includes our diet guide or just the diet guide on its own: the Complete Guide to Renal Diets and Cookbooks), we’ll be taking a look at the least friendly kidney diet foods which you should avoid.

Unfriendly Kidney Foods List
- Beverages
  - Fruit Juices, Soft Drinks, Coffee
    Other fruit juices, not listed in kidney friendly foods and sodas/soft drinks should be avoided due to fructose (fruit sugar) intake, higher potassium and phosphorus levels. Fructose and sugar (mentioned below) added to soft drinks such as soda, ginger ale, etc., and other fruit juices have been shown to create inflammation, contribute to high blood pressure, obesity, diabetes and increase the risk of further damage to the kidneys.
  - Coffee
    Coffee should be limited to 1, 8oz cup per day. We once believed coffee is bad for kidney disease. Recent research possibly shows a benefit. Further studies need to be conducted before a definitive answer is known.
  - Alcohol
    Alcohol consumption should be avoided in CKD. If you want to have alcohol, red wine is preferred for kidney disease.
- Sweeteners and Artificial Sweeteners
  - Sugar/Sucrose
    Sugar, aka sucrose, should be minimized or eliminated in kidney disease. Sugar is very difficult to avoid as it’s added to many products including breads. Small amounts are acceptable within the diet, but large amounts should be avoided by eliminating sugary beverages and large amounts of baked goods, cookies, cakes, pies, candies, etc. High sugar/sucrose intake has been shown to increase the risk of diabetes, worsen its condition, suppress the immune system, increase uric acid, decrease HDL (good) cholesterol, and cause digestive symptoms such as gas, bloating, and diarrhea.
  - Fructose and High-Fructose Corn Syrup
    Fructose, a popular ingredient in beverages, and HFCS should be minimized or avoided, as the problems associated with sucrose and fructose apply to high fructose corn syrup as well.
  - Sugar Alcohols
    Sugar alcohols such as sorbitol, erythritol, xylitol, mannitol, lactitol and maltitol. Not much is known about these sweeteners and their connection to kidney disease. Small amounts in combination with Stevia can be consumed, but they should be limited until further research is conducted.
  - Artificial Sweeteners
    Avoid all artificial sweeteners as some have been shown to be harmful to the nervous system and brain. They can raise the risk of cancer, and there is concern over their involvement in other health problems. Many artificial sweeteners have not been studied in relation to kidney disease and should be avoided until further research is conducted. Here is a list of artificial sweeteners: Saccharin (Sweet’N Low®, SugarTwin®), Aspartame (NutraSweet®, Equal®), Acesulfame K (ACK, Sunett®, Sweet One®), Sucralose (Splenda®), and the recent Neotame.
- Fruits and Vegetables
  Avoid the exotic star fruit, as it has shown to be very toxic to the kidney. Other fruits, vegetables, as well as friendly and moderately-friendly kidney foods may be consumed in liberal quantities if your blood tests show your potassium levels are in range. The issue with these foods is the potassium content. If you need strict control over your potassium levels then the fruits and vegetables not listed should be avoided.
- Carbohydrates
  - Whole Grains
    Whole grains have higher amounts of phosphorus and potassium and should be avoided or limited in the later stages of kidney disease. Choose refined grains, which are usually listed on the package label as refined, enriched, or the grain doesn’t have the word “whole” before it. For example, whole wheat may be listed or just wheat. Whole wheat is the whole grain and if wheat is just listed that is the refined grain. However, in stages 1, 2, and 3 of kidney disease you can have more whole grains in your diet, provided your phosphorus and potassium levels are in mid-range.

We hope you’ve enjoyed this exhaustive, yet by no means comprehensive, look at the ins and outs of three of the most popular chronic kidney disease diets. For the comprehensive, complete guide, be sure to check our shop. We also have plenty of articles and videos about kidney diet foods and recipes for you to peruse at your leisure completely free of charge.

For more information about how to live your life with the healthiest kidneys possible, be sure to follow us all across social media, sign up to your website and check back often, articles are constantly being updated!

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