For individuals managing kidney disease, dietary choices play a crucial role in maintaining overall health and preventing further kidney damage. Among the many dietary considerations, bread often becomes a topic of confusion and concern. This article aims to clarify the role of bread in a renal diet, providing guidance on making informed choices and incorporating this staple food into a kidney-friendly eating plan.
The Importance of Carbohydrates in a Renal Diet
There are few foods as demonized and confusing as bread, especially when it comes to kidney health. White or wheat? Is whole grain better? In short, yes! Bread and other healthy carbohydrates are an important part of a healthy diet for kidney disease. You may be thinking “But doesn’t bread have carbs?”. Answer: yes! Bread is a wonderful source of carbohydrate, and this is a GOOD thing! Carbs have been demonized, perhaps partially due to the “keto” diet craze. But carbohydrates are actually a critical part of a healthy diet for kidney disease. Bottom line: Bread is good for kidney disease! But, you want to make sure you choose mostly healthy, fiber-rich bread.
To understand why bread and carbohydrates are an important part of a kidney friendly diet, we need to go back to Nutrition 101. We get calories from 3 main sources: carbohydrate, fat and protein. In general, diets that are lower in protein are easier on kidneys. If we reduce the calories from one of these 3 groups, the proportion of calories must increase from another. Our bodies need calories to function! For kidney health, it is usually best to reduce calories from protein, increase calories from carbohydrate and continue to eat a moderate amount of calories from fat.
Nutritional Considerations for Kidney Health
When managing kidney disease, it's essential to be mindful of certain nutrients that can impact kidney function. These include sodium, potassium, and phosphorus.
Sodium
A low sodium diet is key to nearly any kidney-friendly diet. Most people should limit sodium to 2,300mg per day. Bread is a surprising source of sodium in the American diet. Up to 10% of the sodium we eat in the United States comes from bread.
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Potassium
Potassium needs vary from individual to individual and depend on a lot of different factors. Some people need to actually be eating MORE potassium. If you’re not sure if you need to be watching your potassium, we recommend discussing with your Doctor or better yet a Renal Dietitian. Renal Dietitians specialize in the nutritional needs of people with CKD.
Phosphorus
Traditionally, white bread was recommended for people with kidney disease because it has less potassium and phosphorus. In 2020, the National Kidney Foundation and The Academy of Nutrition & Dietetics released updated nutrition guidelines for people with Chronic Kidney Disease. These guidelines recommend taking the absorption of phosphorus from different food sources into consideration. Only about 30% of the phosphorus in plant foods, like whole grains, beans, nuts, seeds and lentils, is absorbed. Compare this to phosphorus in meat and dairy, whereabout 80-90% of phosphorus is absorbed. Even worse, phosphorus from food additives is nearly 100% absorbed. So, gone are the days of recommending white bread for kidney disease.
Choosing the Right Bread: Whole Grain vs. White
Historically, white bread was recommended because it has less phosphorus in it. However, we now know that the phosphorus in whole grains like whole grain bread, beans, nuts, seeds and lentils isn’t very well absorbed in our body. So, it is best to choose whole grains more often for all that extra fiber!
As always, the key to finding kidney friendly foods is to look at the nutrition label. Look for ingredients that are “100% whole grain…”. One of the biggest benefits of bread for kidney disease is fiber! Fiber can help control blood sugar, which in turn helps protect your kidneys. Fiber is also good for gut health. We are learning more and more about how the gut and kidneys are connected.
Choosing the right bread can be confusing for individuals with kidney disease. For healthy individuals, whole wheat bread is usually recommended over refined, white flour bread. Whole wheat bread may be more nutritious, mostly due to its higher fiber content. However, white bread is usually recommended over whole wheat varieties for individuals with kidney disease. This is because of its phosphorus and potassium content. The more bran and whole grains in the bread, the higher the phosphorus and potassium contents. Eating one slice of whole wheat bread instead of two can help lower your potassium and phosphorus intake without giving up whole wheat bread entirely. Note that most bread and bread products, regardless of whether they’re white or whole wheat, also contain relatively high amounts of sodium. It’s best to compare the nutrition labels of various types of bread, choose a lower sodium option if possible, and monitor your portion sizes.
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Decoding Bread Labels for Kidney-Friendly Choices
When selecting bread for a renal diet, it's essential to carefully examine the nutrition labels. Pay close attention to the following:
- Sodium Content: Opt for bread with lower sodium levels, ideally less than 200mg per slice.
- Phosphorus Content: While whole grains are now encouraged, be mindful of the phosphorus content, especially if you have elevated phosphorus levels.
- Fiber Content: Choose bread with a higher fiber content, as fiber aids in blood sugar control and gut health.
- Added Sugars: Watch out for sugar ingredients in bread. Remember, sugar is sugar.
- Ingredient List: Look for "100% whole grain" and avoid breads with excessive additives or preservatives.
Sourdough and Rye Bread: Are They Kidney-Friendly?
Sourdough bread is quite tasty, but isn’t necessarily good for kidney disease. “Sourdough” refers to the process of making the bread, not the nutritional value. Rather than yeast, sourdough bread gets it’s rise from fermentation. Typically, sourdough bread is made from white flour. It isn’t better for you than plain old white bread.
Don’t be fooled by it’s dark color. Similar to sourdough, rye bread is not necessarily made with whole grain flour. Most rye bread is made from rye flour that has had the fiber-containing parts of the kernel removed. This is the same process wheat goes through to make white flour. However, you can find whole grain rye bread!
Other Healthy Carbohydrate Options
Remember, bread isn’t the only healthy carbohydrate for kidney disease!
Like whole wheat bread, brown rice is a whole grain that has a higher potassium and phosphorus content than its white rice counterpart. You may be able to fit brown rice into a renal diet, but only if the portion is controlled and balanced with other foods to avoid an excessive daily intake of potassium and phosphorus. Bulgur, buckwheat, pearled barley, and couscous are nutritious, lower-phosphorus grains that can make a good substitute for brown rice.
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Recipe: Kidney-Friendly Banana Bread
This banana bread did not last long around my house! Everyone agreed the turbinado sugar gave it a satisfying crunch. Next time I make it, I will freeze a few slices to reheat later in the toaster oven for an afternoon snack!
This recipe incorporates bananas, which are often a concern due to their potassium content. However, as previously mentioned, potassium needs vary, and portion control is key. This recipe uses three bananas, but each serving of banana bread only has 190 mg of Potassium which is considered a low potassium food.
Ingredients:
- 3 medium over-ripe bananas (about 1⅓ cup mashed or 300 grams)
- ⅓ cup coconut oil, melted
- ⅓ cup brown sugar, packed
- ¼ cup granulated sugar
- 1 teaspoon vanilla extract
- 1 cup all purpose flour (do not pack)
- 1 cup oat flour
- 1 teaspoon baking soda
- 1 teaspoon cinnamon
- ¼ teaspoon salt
- Optional: ½ cup add-ons (sliced almonds, chopped walnuts, vegan chocolate chips)
- 2 tablespoons brown sugar or turbinado sugar
Instructions:
- Preheat your oven to 350℉. Line an 8-inch or 9-inch loaf pan with parchment paper for easier bread removal.
- In a large mixing bowl, mash bananas with a fork or a potato masher. Add melted coconut oil, brown sugar, granulated sugar, and vanilla and whisk to combine.
- In a separate bowl, add your dry ingredients: all purpose flour, oat flour, baking soda, cinnamon, and salt and mix to combine.
- Add the dry ingredients into the banana mixture and stir with a spoon (do not whisk) until just combined and no flour pockets remain. Do not over mix or your banana bread will turn out tough. If batter is too dry, add 1-2 tbsp of dairy-free milk as needed.
- Optional step: Add your optional ½ cup of add-ons and fold until well distributed. Do not over mix the batter.
- Pour batter into the lined loaf pan. Sprinkle 2 tbsp of brown sugar on the surface of the loaf before baking.
- Place in the oven and bake for 50-55 minutes or until a toothpick inserted to the center comes out clean. Let cool for at least 15 minutes before removing from the loaf.
Recipe Notes:
- Bananas: make sure to use over-ripe bananas for this recipe. Their skin should start having brown spots on them and the flesh should be mushy and sweet.
- Flour: make sure not to pack your flour when measuring otherwise the recipe will come out very dry. To measure properly, use a spoon to lightly scoop flour into your measuring cup, then level it off with a knife. Do not scoop flour directly into the measuring cup or shake the measuring cup to level off the flour.
- Oat Flour: For homemade oat flour, blend rolled oats first to a fine powder, then measure to 1 cup with the technique described above, and use without sifting to add a nice chew. If using store bought oat flour, make sure to measure properly without packing the flour.
Nutritional Information (per slice):
- Calories: 244kcal
- Carbohydrates: 40g
- Protein: 3g
- Fat: 9g
- Saturated Fat: 6g
- Polyunsaturated Fat: 1g
- Monounsaturated Fat: 1g
- Sodium: 173mg
- Potassium: 199mg
- Fiber: 2g
- Sugar: 19g
- Vitamin A: 23IU
- Vitamin C: 3mg
- Calcium: 21mg
- Iron: 1mg
Plant-Based Egg Substitutes for Kidney-Friendly Baking
Eggs are often part of many baking recipes, as they provide structure, leavening, texture, and flavor. However, if your goal is to follow a more plant-based diet, there are many alternative options.
Here are some egg substitutes in banana bread that allow a more plant-based approach to baking but are still kidney friendly:
- Bananas: Using banana as an egg replacement adds moisture, sweetness, and a hint of banana flavor. This substitution works well in quick breads, muffins, cakes, and pancake recipes. We recommend using half of a ripe banana (approximately 1/4 cup mashed) for one egg. Depending on the recipe, you may need to increase the leavening agent by 1/2 teaspoon.
- Applesauce: Applesauce is another great egg substitute in quick breads, muffins, and cakes. The flavor is subtle, but will add moisture and sweetness to your recipe. We recommend replacing 1 egg with 1/4 cup applesauce and increasing the leavening agent by 1/2 teaspoon. Use applesauce when a recipe only calls for one egg as too much of this ingredient will affect the structure of the end product.
- Flax or Chia Seeds: The consistency of flax and chia seeds (when combined with water) make them a great binder and source of moisture in baking. Use this substitution in brownies, cookies, quick breads, muffins and cakes. They also are a great source of fiber and omega-3 fatty acids. To prepare flax or chia seeds to use as an egg replacement, combine 2 1/2 tablespoons of water with 1 tablespoon of ground flax or chia seeds. Let it sit for 5-10 minutes before adding to a recipe.
Making Your Own Bread: A Satisfying and Healthy Option
Learning to make your own loaf of bread is immensely satisfying. This recipe bakes the bread in a Dutch Oven, a method popularized by New York City baker Jim Lehey of Blue Ribbon Bakery. The steam is trapped inside the Dutch Oven and results in the beautiful, hard crust. Combine yeast, sugar and warm water into a bowl. Add salt and flour to the bowl. Remove Dutch oven from the oven after 15 minutes, very carefully, with oven mitts. Remove from the oven and let cool.
Foods to Limit or Avoid on a Renal Diet
If you have kidney disease, it’s important to watch your intake of sodium, potassium, and phosphorus. Here are 17 foods you should try to limit or avoid on a kidney diet:
- Dark-colored sodas
- Avocados
- Canned foods
- Whole wheat bread (in some cases)
- Brown rice
- Bananas
- Dairy products
- Oranges and orange juice
- Processed meats
- Pickles, processed olives, and relish
- Apricots
- Potatoes and sweet potatoes
- Tomatoes
- Processed foods
- Leafy green vegetables (cooked)
- Dates, raisins, and prunes