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Healthy eating for people with chronic kidney disease (CKD)

What is CKD

Chronic Kidney disease is a long – term condition where the kidneys do not work well. It does not usually cause symptoms until later stages. CKD is normally found at earlier stages by blood and urine tests. Your GP can tell you what stage of kidney disease you have.

This information is for people who have early-stage CKD. If you have late CKD you will see a specialist kidney (nephrology) team with a kidney Dietitian.

More information about CKD can be found here: https://www.nhsinform.scot/illnesses-and-conditions/kidneys-bladder-and-prostate/chronic-kidney-disease

How does a healthy diet help my kidneys?

Healthy eating is good for everyone. Some aspects are especially important for people with early-stage CKD.

One of our kidneys jobs is to get rid of the waste products from food breakdown. When you have CKD, your kidneys are not able to do this well. A healthy diet makes less waste and puts less stress on the kidneys.

Healthy eating can help manage diabetes, obesity, and high blood pressure. Controlling these conditions can help protect the kidneys too.

The information in this leaflet is suitable for you if you are living with diabetes, obesity or high blood pressure.

Read more to find out how to eat well for your kidneys and overall health.

What is a healthy diet?

A healthy diet has a good balance of different foods and nutrients each day to keep you healthy and well. Healthy eating is not about restricting your intake. It is about choosing a variety of different foods each day; in the amounts you need to keep you well.

The Eatwell Guide helps to explain what a healthy diet looks like. You can find more information about the Eatwell Guide here: https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/

Eat more of these:

·        Fruit and vegetables are a key part of healthy eating. They provide vitamins, minerals and fibre to keep you and your kidneys well. Aim to enjoy 5 portions of fruit and vegetables a day, or more if you can. Choose a variety to ensure you get different vitamins. This can be from fresh, frozen, dried or canned fruit and vegetables. One portion is approximately one handful·   

·       Starchy foods like bread, potatoes, pasta, rice and other grains are part of a healthy diet. These foods are a key source of energy for the body.

·       If you can, choose wholegrain products like wholemeal bread, brown rice, wholewheat pasta, oats and potatoes with skins on to ensure you get more fibre, and vitamins. Beans, lentils, chickpeas and other pulses provide protein. They are also high in fibre and low in less healthy fats.

·        Regularly replacing some of your meat with these pulses may help to slow the loss of kidney function.

Eat some of these:

·       Animal protein foods like fish, eggs, meat, milk, yoghurt and cheese provide a range of vitamins and minerals. They can be part of a healthy diet when eaten in moderate amounts. However, it is best to eat more plant sources of protein such as lentils, pulses, legumes, tofu or nuts and less meat, especially red meat.

·        Oily fish like salmon, mackerel or sardines provide a source of omega-3 (a healthy fat). Enjoy one portion of fish per week. Or you can obtain Omega-3 from rapeseed oil, walnuts or seeds (hemp, chia or flax/linseeds).

·        Dairy foods provide protein, calcium, B vitamins and iodine. It is best to go for lower fat and lower sugar versions (for example natural yoghurt) most of the time. If you use a plant-based-dairy alternative, choose one that is fortified with calcium. It is best to limit plant milks and dairy alternatives (such as yoghurt) to 300 ml (half a pint) a day if they have phosphate additives listed in the ingredients.

Eat small amounts of these:

·        We need fats and oils in small amounts. It is best to choose fats like olive oil, nut, seed or healthy vegetable oils, such as rape seed oil. Limit less healthy fats such as coconut and palm oil, butter, lard and ghee.

·        If you can, it is best to keep processed foods to a minimum. Foods that are pre-packed, or have added fat, salt, sugar and / or additives are processed. Ready meals are processed. This also includes meats or fish that are salted, cured, smoked, coated, breaded or battered.

Eat less of these:

·        Food or drinks that are high in less healthy fats, salt and sugar are best eaten only occasionally. These items include chocolate, cakes, biscuits, pastry, crisps, fried chips and sugary drinks. Try to keep portion sizes small.

Note: it is advisable to avoid star fruit. Star fruit has a toxin that can build-up in the body and become harmful to those with kidney disease.

Reducing salt:

Reducing salt is helpful for everyone with CKD. Most of us eat more salt than we should. Salt is added to many foods before we buy them as part of the food manufacturing process,

Eating salt and salty foods increases your blood pressure. Limiting the amount of salty foods, you can eat can help keep blood pressure under control and reduce further damage to kidneys.

Salt can also make you thirsty and makes fluid retention worse.

It is recommended to have less than 5g (one teaspoon) salt per day. Most of this salt is likely to be naturally occurring in the foods you eat. Your taste buds will adapt to less salt, but this may take about 3 weeks.

Tips to reduce salt include:

·         If you can, limit processed or convenience foods and takeaways. If you do eat these, check labels and choose versions that are lower in salt.

·         Cook meals from scratch wherever possible

·         Try not to add salt in cooking or at the table. This includes all types of salt, e.g. Lo Salt or other lower sodium salts, rock salt, sea salt, Himalayan pink salt, garlic and kosher salts etc. Salt substitutes such as Lo-salt or other low sodium salts contain a lot of potassium and are not always suitable for people with kidney disease.

·         Use reduced salt stock cubes in your cooking, rather than standard cubes. These are available in most supermarkets. Flavour food using a variety of fresh or dried herbs, spices, garlic, ginger, onions, vinegars, lemon or lime juice. Be careful with seasoning mixes as these can contain a lot of salt.

Understanding food labels:

Reading and understanding food labels can look complicated and time consuming, but gets easier with practice. If you shop online, this information is available on the supermarket websites.

Having less salt:

Some foods may be labelled “reduced salt” but could still be quite high in salt.

Remember to look at the “Traffic Light Symbol” on the front of the packaging. It will look something like this.

 

Choose foods that are green or amber for salt. Have less of these that are coloured red.

If there is no traffic light symbol, check the nutritional information on the back of food packaging. This may tell you the amount of salt per 100 g of the product, or per portion.

 

 If the label provides the salt per 100 g, compare with the table below

Per 100g

Low

Medium

High

Salt

0-0.3g

0.3-1.5g

More than 1.5g

 

If the food label only says how much is in a portion, consider how much of that food you are planning to eat. The manufacturer’s portion size might be different from yours. Check the portion size on the label and compare it to your own. Picking a larger or smaller portion can have a big impact on the amount of salt you consume.

Phosphate:

Avoiding phosphate additives in your food can be helpful if you have CKD. Too much phosphate from additives can be harmful to your heart, kidneys, and bones.

Many processed foods contain phosphate additives. The good news is you can usually find a similar product without these additives. You can check in the ingredients list on the label. Most people find the easiest way is to look for “phosp” as part of a word on the list.

However, sometimes a label only shows “E numbers”. Here is a list of E numbers to watch out for. Some people find it useful to carry a credit card-sized list while shopping, or you can save the numbers on your phone.

Cooking from scratch more often will help to reduce the amount of additives you eat. 

Note: You can enjoy foods that naturally contain phosphates unless your kidney care team tells you otherwise. Our bodies don’t absorb natural phosphates as easily as phosphate additives. If you need guidance on your diet, a kidney Dietitian will assist you in choosing the right foods, including those without additives.

E338

Phosphoric acid 

E339

Sodium phosphates

E340

Potassium phosphates 

E341

Calcium phosphates

E343

Magnesium phosphates

E450

Diphosphates

E451

Triphosphates

E452

Polyphosphates

Special Diets

Many people with CKD won’t need to follow special diets. However, those with more advanced CKD may be advised to make changes to their potassium, phosphates, protein, or fluid intake.

The advice you receive about limiting these nutrients will depend on your CKD stage, blood results, medications, and how you like to eat. If you’ve been told to make dietary changes, a kidney Dietitian can help you create a healthy, balanced and enjoyable diet while taking your condition in to account.

You should not restrict your diet unless you have been advised by your Kidney Doctor or Dietitian to do so.

Poor Appetite

If you’re in the advanced stages of CKD and find yourself often not feeling hungry, it’s a good idea to speak with to a kidney Dietitian. They can provide assistance for issues like not wanting to eat much, changes in taste, feeling sick, vomiting or losing weight without meaning to.

Vitamin and mineral supplements

If you are eating well and enjoying a varied diet, there is no need to take a vitamin and mineral supplement. If you do want to take a supplement or herbal remedy, discuss this with your kidney Doctor first. They can help to ensure it is safe to take.

Other lifestyle guidance

Alcohol

General guidance is to try not to exceed 14 units of alcohol each week. If you do drink, spread your drinking evenly over three or more days and have several alcohol-free days per week (always check alcohol consumption is safe with your medication).

Exercise

Staying active is key to staying healthy. Exercise not only strengthens your bones and muscles but also helps you manage your weight, blood pressure, and diabetes.

Aim to do 150 minutes of moderate intensity aerobic activity each week. For example, you can take a 30-minute walk five times a week. However, any exercise is better than none at all. Start slowly and gradually increase your activity based on your current fitness.

Smoking

If you currently smoke, then it is advisable to stop. There are special services to help you stop smoking. You can find out more about this at your GP practice.

Summary

·         Enjoy a varied healthy diet, rich in vegetables, fruits, wholegrains and pulses each day.

·         Eat regularly and try not to miss meals.

·         Eat less salt, foods that are high in salt and processed foods.

·         Check food labels to cut down your intake of phosphate additives.

·         Good control of blood pressure, diabetes and keeping to a wealthy weight are helpful to slow the progression of your CKD down.

·         Discuss any over the counter supplements with your kidney Doctor before taking them.

·         Only follow a special diet for your kidneys if you have been advised to by your kidney Doctor or Dietitian.

 

This information written by The Renal Nutrition Group © September 2023

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