By: Kelsie White, RDN
What diet comes to mind when you think of a diet for chronic kidney disease (CKD)? If you are like most people, you have probably heard to avoid certain foods like fruits, vegetables, and whole grains and instead prioritize white grain products and animal-based foods for management of CKD. But today, I want to suggest to you that a whole food, plant-based (WFPB) diet may be just what to you need to prevent and even manage CKD.
First, let’s start by defining what a whole food, plant-based diet is. According to the American College of Lifestyle Medicine, a whole food, plant-based diet is one that consists of mostly “vegetables, fruits, legumes, whole grains, nuts, and seeds. It is high in fiber and antioxidants and is low in total added fat, saturated fat, added sugar and added salt.” Basically, the idea here is that this type of dietary patterns focuses on obtaining the majority, if not all nutrients from whole, plant foods rather than processed foods or animal products.
There are many benefits to a WFPB diet such as a reduced risk for several chronic diseases, but there are some benefits that are specific to chronic kidney disease. A few of these benefits include:
There are several blood and urine tests that are utilized to help diagnose chronic kidney disease. Some blood tests include blood urea nitrogen (BUN) and creatinine, as well the glomerular filtration rate (GFR), or the rate at which your kidneys are able to filter your blood. Urine test examples include urine protein and urine albumin. The diagnosis of CKD is complex and is beyond the scope of this article. However a good rule of thumb is that a GFR of <60 can indicate CKD and a GFR of >60 means that further testing should be done. For more information on testing for kidney disease, check out this article from the Centers for Disease Control and Prevention.
Once an individual has been diagnosed with CKD, there are certain dietary restrictions that are recommended. Traditionally, these recommendations have consisted of limiting foods like vegetables, fruits, whole grains, beans, and legumes in order to control intake of potassium and phosphorus. These recommendations also focused on emphasizing animal proteins and highly processed grain products like white bread and cereals.
One of the problems with following traditional recommendations like this is that it often leads to a diet that is very low in fiber and other key nutrients. A diet focused on animal products and processed foods is not health-promoting and can lead to an increased risk of other chronic diseases including diabetes and heart disease. As research continues to progress in the field of nutrition, so does our understanding of the role that diet plays in many diseases, and we are continuing to see the many health benefits of recommending a plant-based diet for those with various stages of CKD, including those health benefits listed above.
There are a few nutrients that need to be discussed further when it comes to CKD. These include protein, sodium, potassium, and phosphorus. These nutrients are either restricted or encouraged depending on the stage of CKD, and all of these can be addressed through a WFPB diet.
Depending on the stage of CKD, protein needs are either decreased or increased. Despite this, when focusing on plant proteins, this can help lead to a lower potential renal acid load, as well as less nitrogenous waste and uremic toxins. For the protein content of various plant foods, check out this
Sodium is restricted in a renal diet because when the kidneys are damaged, they are unable to efficiently remove extra sodium and fluids from the body. The good news is that a WFPB is naturally very low in sodium. Even if you choose to cook with salt, you are still likely going to consume less sodium than someone who eats a standard American diet with processed foods (the main culprit of sodium).
When it comes to potassium, this is the nutrient that will take some more careful consideration and planning. This is because plant foods like fruits, vegetables, and legumes are naturally high in potassium. If your lab values for potassium are within normal limits, then this will not be a concern for you. If your potassium is elevated, however, there are actually a few cooking methods that can help to reduce the amount of potassium in a given food. Soaking or cooking foods in hot water like beans, potatoes, beets, and carrots can help to reduce the amounts of potassium. Another way to assist your potassium levels if they are elevated is to choose lower-potassium foods most of the time, with high-potassium foods being consumed less frequently and in smaller portions. Either way, it is best to speak with your doctor to find out if a potassium restriction is necessary.
The key to phosphorus is in how much of it is actually absorbed by the body. Phosphorus found in certain foods will have a higher percentage of it absorbed than others. Can you guess which type of foods will have less phosphorus absorbed? Plant foods. Phosphorus found in plants is only 10-40% absorbed, whereas phosphorus found in animal products and additives like dark sodas is 40-100% absorbed. That is a big difference, and really opens up your options for consuming high-phosphorus plant foods.
Many of the recommendations presented here are meant to be general. The key, however, comes in personalizing these recommendations to your specific needs and disease state. This is because recommendations for certain nutrients like protein, phosphorus and potassium depend on which stage of CKD you are currently in and what your lab values look like. This is where working with a team of healthcare providers can be beneficial in determining your unique needs and recommendations. If you are interested in becoming a patient of Lifestyle Medical and would like guidance on management of CKD through diet, click here for a free meet and greet with one of our providers.
Now let’s talk about some small steps to help you start on your journey to preventing or managing chronic kidney disease with a whole food, plant-based diet. First is to increase fruit and vegetable intake. Again, this must be based on your individual needs depending on the progression of your disease. The next step is to start swapping animal proteins for plant proteins. Beans, legumes, soy, tofu, nuts, and seeds are just a few examples. Lastly, start focusing more on whole plant, foods, rather than their processed counterparts. These foods can often be sources of additives that are hard for the kidneys to handle, such as sodium and phosphorus.
Looking for even more information to help get you started on your journey? Check out Plant Based Kidneys for recipes, blogs, online courses and more. For meal plans based on stages of CKD, check out CKD Stages 1-3 and CKD Stages 4-5.
Preventing and managing chronic kidney disease is possible with a whole food, plant-based diet. Take control of your kidney health today!
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