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Building a Balanced Vegetarian Kidney Diet
Can a kidney diet also be a vegetarian diet? It’s estimated that about 5% of people on dialysis are vegetarians. Some of the reasons for following a vegetarian diet include religious, cultural, social and personal beliefs. Others adapt a meat-free diet because of taste changes due to uremia as a result of chronic kidney disease (CKD). Vegetarians generally avoid all animal products including eggs, beef, pork, poultry, fish and seafood.
Limiting high protein foods may help slow the progression of CKD. Diets rich in red and processed meat are linked to higher rates of heart disease, cancer and death. Vegan and vegetarian diets are becoming more popular. This makes it easier for people to accept and follow protein-restricted vegetarian diets.
Wondering about how safe it is to follow a vegetarian diet? The Academy of Nutrition and Dietetics consider vegetarian diets to be safe, provided that low levels of vitamins and minerals like iron, vitamin B12, and vitamin D are corrected by supplements.
Some kidney patients may require protein and calorie supplements depending on lab results for albumin and presence of inflammation. Diet recommendations differ for patients with CKD stage 2 to 4 compared to stage 5. The protein recommendation is 0.6 to 0.8 g/kg/day for patients with CKD stage 3 and 4. Vegetarian diets usually contain between 0.6 and 0.8 g/kg/day of vegetable proteins and may be less damaging to kidneys. CKD stage 5 patients on dialysis need a higher amount of protein: 1.0 to 1.2 g/kg/day due to protein loss during dialysis. Patients on dialysis may require nutrition drinks or bars to help meet their nutrition needs.
Balancing phosphorus can be a challenge when choosing a vegetarian eating plan. Extra phosphate binders, if prescribed, may be required in order to include whole grains, beans and nuts. Also, for those on dialysis it is important that adequate dialysis is prescribed in order to control waste build-up in the blood.
Very little is known about the toxic effect of phosphorus food additives, preserving agents or taste enhancers in ready to eat and processed foods. Phosphorus is usually not included on the nutrition label but is included in the ingredient list. It is recommended to avoid foods with ingredients that include “phos” in the name. This is because 90 to 100% of phosphorus from the inorganic phosphorus (additives) is absorbed quickly and easily and therefore should be avoided. According to some studies by Kalantar et al., only about 50% of organic sources of phosphorus (beans and nuts as their protein source) are absorbed by the gastrointestinal tract. Because humans do not completely digest these foods, the amount of phosphorus absorbed from grains, beans and peas, and nuts is relatively low. Looking only at the milligrams of phosphorus in foods is no longer the best way to create a kidney-friendly diet.
Recent studies highlighted the concerns about phosphate additives and warned about sodium and potassium content. It is especially important for vegetarians as most textured protein foods are preserved and have high sodium content. It is important to read nutrition labels for sodium content. Sodium and potassium should be limited to 2000 mg/day for most patients on hemodialysis.
If you are interested in starting a vegan or vegetarian diet, or if you are already following one, your dietitian can help. They can help determine your nutrient needs, and if your current intake is adequate. They can help adapt your eating plan for different stages of CKD to be sure you build a balanced vegetarian diet.
Try one of these kidney-friendly vegetarian dishes from DaVita.
Reference: Kalantar–Zadeh et al; Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease. Clin J Am Soc Nephrol 5: 519-530, 2010.