Diabetes and chronic kidney disease often go hand in hand. In fact, diabetes is one of the leading causes of kidney disease due to the damage high blood glucose levels can cause to the blood vessels in the kidneys over time. Managing both conditions requires careful monitoring and lifestyle changes, especially when it comes to diet. For those with diabetes and kidney disease, it’s important to be mindful of certain foods and nutrients that can negatively impact kidney function and overall health if consumed in excess. In this article, we will discuss the top 7 foods to limit or avoid when living with diabetes and kidney disease.
#1.High Sodium Foods
Sodium, or salt, is one of the most important nutrients to limit with kidney disease. The kidneys play a key role in regulating fluid balance and blood pressure in the body. When kidneys become damaged, they lose some of this regulation ability, making it easier for excess fluid to build up in the body (edema). Consuming too much sodium contributes to this fluid retention issue. It’s recommended those with kidney disease consume no more than 2,300mg of sodium per day. This is equivalent to about 1 teaspoon of table salt. Be mindful of sodium in packaged, canned and frozen foods which can be very high. Opt for fresh foods when possible and rinse canned goods to remove some sodium. Watch out for “hidden” sodium in breads, sauces and condiments too.
#2. Too Much Protein
Protein is an important part of a balanced diet, however, those with reduced kidney function need to be cautious about protein intake. This is because kidneys play a role in processing protein. When kidney disease is present, protein waste can build up in the bloodstream if consumed in excess. Generally, those with kidney disease should aim for 0.6-0.8 grams of high-quality protein per kilogram of body weight daily. Good sources include skinless poultry, fish, eggs, low-fat dairy and nuts/seeds. Limit red meat to 3-4 ounces daily. Avoid protein supplements without medical guidance.
#3. Certain Herbal Supplements and Vitamins
Many herbal supplements and high doses of certain vitamins can place added strain on the kidneys or interact with medications. Supplements like creatine, licorice root, stinging nettle and parsley are best avoided. Fat-soluble vitamins A, D, E and K may also accumulate if kidney function is low and excess intake should be discussed with your healthcare provider. Water-soluble vitamins like B vitamins and C are generally safer when taken within recommended daily limits. Check with your doctor before starting any new supplements.
#4. Foods High in Potassium
Potassium is an important mineral that plays many roles in the body but must be regulated tightly. With kidney dysfunction, potassium levels can rise to dangerous levels. High potassium foods to be mindful of include bananas, oranges, potatoes, tomatoes, beans, lentils and supplements/salt substitutes. Always read nutrition labels. While potassium is essential, too much from food alone can overburden the kidneys. Be sure to discuss an individualized daily upper limit with your doctor or dietitian.
#5. Foods High in Phosphorus
Like potassium, phosphorus is an important mineral but also needs close monitoring with kidney disease. Good dietary sources of phosphorus include dairy products, red meat, poultry, fish, nuts and beans. Again, the kidneys regulate phosphorus levels in the blood, so excess can build up in those with reduced function. Phosphorus adds up quickly from multiple servings of high sources daily. Limit dairy to 1-2 servings and check nutrition labels for phosphorus grams listed. Work with your provider on determining your daily phosphorus intake needs.
#6. Trans Fats
These bad fats have been shown to negatively impact cardiovascular and kidney health. Foods containing trans fats like margarine, fried foods, packaged baked goods and snack foods should be avoided as much as possible. While small amounts may be present naturally in some animal foods, eliminated added trans fats from packaged/restaurant foods can help keep inflammation in check.
#7. Excess Alcohol
Drinking in moderation for the general population is 1 drink daily for women and 2 for men. But with kidney disease, it’s best discussed with your doctor given the extra stress alcohol places on the kidneys to filter out toxins. Even moderate alcohol can worsen high blood pressure, cause dehydration and negatively impact kidney function over the long term. Most guidelines recommend no more than 1 standard drink 2-3 times weekly, if any, for those with kidney disease.
Kidney-Safe Food Swaps
Eating right with kidney disease and diabetes takes some adjustment but is very possible with the right swaps:
- Replace high sodium canned and processed foods with fresh or low-sodium options.
- Substitute one serving of high-potassium fruit for a lower-potassium option like melon each day.
- Use aluminum-free baking powder in home baked goods.
- Choose low-sugar whole grains like quinoa, oats and brown rice instead of white rice and pasta.
- Snack on unsalted nuts and seeds in moderation.
- Drink plenty of water and unsweetened herbal tea for hydration and to flush out waste.
- Lean proteins like chicken, beans, lentils, eggs can replace some red meat servings.
- Use heart-healthy fats like olive oil, avocado and nut butters for flavor.
Checking with your medical team on an individual meal plan tailored to your needs can help you meet nutrition requirements without overdoing any one nutrient. With kidney-friendly choices, you can manage blood sugar and support kidney health long term.
Dietary Approaches
For some with more advanced chronic kidney disease (CKD) who need stricter dietary modification, there are three main approaches your registered dietitian may recommend.
- The Low-Protein Diet limits protein to 0.6g/kg body weight daily to help preserve kidney function. Extra amino acid supplements may also be included.
- The Very Low-Protein Diet further restricts protein to 0.3g/kg body weight daily. This is generally only for latestage CKD and is closely monitored.
- The Kidney Diet Exchange List method allows for protein foods to be “exchanged” for lower-protein alternatives based on a points system. This offers more flexibility.
These clinical diets may involve weighing and measuring portions very precisely using visual guides or gram scales. Supplemental nutrition through oral or tube feeding may also be suggested. While restrictive, clinical diets can help slow further kidney decline when followed as directed by a nephrologist and dietitian.
Monitoring Nutrition Status
The kidneys regulate not only waste removal but also vitamin, mineral and hormone balance. With impaired function, nutritional deficiencies may occur over time. Some frequent tests your doctor may recommend include:
- Complete blood count (CBC) – checks red blood cell production which requires certain vitamins and minerals.
- Comprehensive metabolic panel (CMP) – evaluates electrolytes, BUN/creatinine levels, albumin and more to monitor nutritional status.
- Vitamin D, PTH and calcium levels – important for bone health but regulated by kidney function.
- Nutrient-specific tests like iron, magnesium, prealbumin – done if deficiencies are suspected.
Your dietitian or nephrologist will keep a close eye out for any imbalances via regular lab work. Diet may need adjusting or supplements adding if nutritional concerns arise. Early identification of potential issues allows for timely treatment or diet interventions.
Partnering with Your Healthcare Team
Managing kidney disease and diabetes through diet alone can feel overwhelming. Having the support of your physician, registered dietitian and pharmacist is invaluable in developing an individualized meal plan tailored for your lifestyle, preferences and medical needs. They can:
- Interpret lab work results and monitor your nutritional status over time.
- Adjust diet recommendations if medication changes occur that impact nutrition requirements.
- Help problem-solve challenges and answer questions about certain foods, eating away from home and managing social eating.
- Recommend appropriate nutritional supplementation if deficiencies are detected on lab work or needs cannot be met through diet alone.
- Provide nutrition education tools like food lists, meal plans, cooking demos and recipe ideas for following your prescribed diet.
Eating well may seem difficult when you first receive your diagnosis, but with the guidance of your healthcare team, you can take positive steps toward managing your health through nutrition and lifestyle. Commit to communicating openly with your providers so you get the support needed along your journey.
In summary, making informed choices about sodium, potassium, protein, phosphorus, herbal supplements and added sugars can go a long way in protecting kidney function and metabolic health for those living with both diabetes and chronic kidney disease. Individualizing your meal plan with your medical providers allows you to enjoy a balanced kidney-friendly diet for life.
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