Chronic Kidney Disease (CKD) affects a significant portion of the population, particularly older adults. Managing CKD often involves dietary adjustments to support kidney health and prevent further damage. The National Kidney Foundation is a valuable resource, providing educational materials and support for patients and their families. This article explores the role of unsalted butter within a renal diet, along with other kidney-friendly food choices.
Understanding the Renal Diet
When you have chronic kidney disease (CKD), you may need to make changes to your diet, to keep the levels of electrolytes, minerals, and fluid in your body balanced. The purpose of this diet is to keep the levels of electrolytes, minerals, and fluid in your body balanced when you have CKD or are on dialysis. People on dialysis need this special diet to limit the buildup of waste products in the body because most people on dialysis urinate very little. A healthy diet includes adding vegetables and fruit every day. Vegetables like broccoli, green beans, leafy greens, zucchini, cauliflower, cabbage, carrots, and tomatoes are low in calories and high in fiber, vitamins, and minerals. Fruit is also a good source of fiber, vitamins, and minerals.
A renal diet aims to minimize the strain on the kidneys by controlling the intake of certain nutrients, including sodium, potassium, phosphorus, and protein. It is essential to consult with a healthcare provider or a registered dietitian specializing in kidney diets to create a personalized dietary plan that meets individual needs and health conditions.
The Role of Fats in a Renal Diet
Fats can be a good source of calories. Dietary Guidelines recommend to restrict saturated fats to less than 10% of total calories to reduce the risk of heart disease (1). The Dietary Guidelines for Americans 2020-2025 recommend that people cook with vegetable oils such as canola, olive, peanut and safflower, instead of butter, lard or coconut oil. Make sure to use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) to protect your heart health. Talk to your provider or dietitian about fats and cholesterol that may increase your risk for heart problems.
Unsalted Butter: A Renal-Friendly Option?
You may enjoy the rich flavor of butter or margarine on bread, pancakes, baked potatoes or grits. However, you may wonder which one is the best kidney-friendly option. Both butter and margarine are fat. Butter is mostly saturated fat, while margarine is mainly unsaturated fat. So, the next time you’re at the grocery store look for options that do not contain saturated or trans fats. Remember to use butter, margarine or plant-based spreads in small amounts and check the Nutrition Facts Label for more information.
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When following a renal diet, it’s crucial to minimize sodium intake. Unsalted butter is a better choice than salted butter because it allows for greater control over sodium consumption. Each tablespoon of salted butter has 91mg of sodium. And with butter as an ingredient in pretty much every holiday recipe, that's going to add up quickly.
Limiting Sodium Intake
Reducing sodium in your diet helps you control high blood pressure. It also keeps you from being thirsty, and prevents your body from holding onto extra fluid. Look for these words on food labels: Low-sodium, No salt added, Sodium-free, Sodium-reduced, Unsalted. Check all labels to see how much salt or sodium foods contain per serving. Also, avoid foods that list salt near the beginning of the ingredients. Look for products with less than 100 milligrams (mg) of salt per serving. A common daily sodium intake goal is 1,500 mg per day. DO NOT use salt when cooking and take the salt shaker away from the table. Most other herbs are safe, and you can use them to flavor your food instead of salt. DO NOT use salt substitutes because they contain potassium. People with CKD also need to limit their potassium.
Managing your sodium intake is an important part of looking after your health-especially if you’ve been diagnosed with chronic kidney disease (CKD). The recommended daily sodium intake for adults is 2300 mg/day-which is a little less than a teaspoon of table salt. If you’re living with kidney disease, too much sodium in your diet can cause further health issues. With CKD, the recommended daily amount is lower than average, usually less than 2000 mg. Following a low sodium diet can help you manage your health and protect your kidneys. When your body has too much sodium, it may start to retain fluid. If you're living with CKD, following a low sodium diet is important to your health.
Other Fats to Consider
While unsalted butter can be included in moderation, it’s essential to consider other fats as well. Butter contains saturated fat, which increases your risk for heart disease. The National Kidney Foundation notes that heart disease is a major risk factor for kidney disease and vice versa. The Dietary Guidelines for Americans 2020-2025 recommend that people cook with vegetable oils such as canola, olive, peanut and safflower, instead of butter, lard or coconut oil. Margarine is made from vegetable oil and is higher in the "good" fats, but may not be a better choice because it often contains trans fats. When possible, use canola or olive oil instead. If you opt for a spread, go for one that is lower in calories and saturated fat and contains no trans fats.
Low-Sodium Food Choices
When you’re choosing low salt foods, knowing what words to look for can help you make wise choices. Many foods are specifically labeled as sodium-free or low sodium. This can be helpful when buying foods like canned vegetables and juices. Just know that it’s possible for foods to have less sodium than normal and still contain more than you need, so read food labels and keep your sodium goal in mind. Low sodium foods include:
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- Fresh or frozen fruits
- Fresh or frozen vegetables without sauce
- Whole grain rice or pasta
- Canned beans, rinsed or with no sodium added
- Beef, pork, chicken and turkey with no added seasonings or brines
- Fresh or frozen fish
- Eggs
Prioritizing Kidney-Friendly Foods
In addition to monitoring fat and sodium intake, a renal diet involves selecting foods that are gentle on the kidneys.
- Cabbage: Compared with many fruits and vegetables, cabbage is lower in potassium, and this leafy green packs a lot of nutritional punch.
- Cranberry Juice: Cranberries are increasingly thought of as a functional food (providing more health benefits than basic nutrition) because they’re a concentrated source of antioxidants.
- Radishes: Kick up the flavor by adding radishes to your plate. Radishes are low in sodium and potassium and keep well in the refrigerator.
- Pineapple: Pineapple is a natural treat that won’t overload you with sodium, protein, or potassium.
- Applesauce: With fewer than 150 milligrams of potassium per half-cup serving, applesauce lets you add sweetness to your menu without overdoing it on potassium.
- Sunflower Seeds: Nuts and seeds are good sources of healthy fats, protein, vitamins, and minerals. However, some varieties are too high in protein or potassium for people with CKD. Sunflower seeds are relatively low in phosphorus, potassium, and protein.
- Onions: Onions are filled with fiber, antioxidants, and flavor. In particular, onions are high in soluble fiber, which is beneficial for lowering cholesterol and keeping blood sugar stable. They’re also lower in potassium than many other veggies.
Foods to Limit or Avoid
Changing your diet by avoiding or limiting certain foods can also help protect your kidneys from further damage.
- Red meat: Red meat contains a large quantity of protein. Low-protein diets may be helpful before you start dialysis. Your provider or dietitian may advise a lower-protein diet based on your weight, stage of disease, how much muscle you have, and other factors. But you still need enough protein, so work with your provider to find the right diet for you. Once you start dialysis, you will need to eat more protein. A high-protein diet with fish, poultry, pork, or eggs at every meal may be recommended. People on dialysis should eat 8 to 10 ounces (225 to 280 grams) of high-protein foods each day.
- Peanuts: Peanuts contain oxalates, a type of mineral found in kidney stones. In fact, calcium oxalate kidney stones are the leading type of kidney stones, according to the National Kidney Foundation.
- Canned vegetables: While vegetables are very good for you, canned vegetables usually contain a large amount of sodium. Having too much sodium in your system makes it difficult for your kidneys to remove excess fluid from your bloodstream.
- Processed meats: Processed meats contain a significant amount of sodium and protein, both of which are hard on your kidneys.
- Avocados: Avocados contain potassium, a mineral that controls nerve and muscle function. Excess potassium in the blood, a condition known as hyperkalemia, often occurs in people with advanced stages of kidney disease.
- Liver and other organ meats: Liver and other organs meats have high concentrations of purine.
- High-phosphorous foods: It’s recommended to avoid high-phosphorous foods, such as yogurt, milk, and cheese, but butter, margarine, heavy cream, ricotta, and brie cheese contain lower levels and may also be approved as part of the older adult’s dietary plan.
Managing Potassium Levels
Normal blood levels of potassium help keep your heart beating steadily. However, too much potassium can build up when the kidneys no longer function well. Dangerous heart rhythms may result, which can lead to death. Fruits and vegetables contain large amounts of potassium, and for that reason should be limited to maintain a healthy heart.
When eating fruits, choose peaches, grapes, pears, apples, berries, pineapple, plums, tangerines, and watermelon. Limit or avoid oranges and orange juice, nectarines, kiwis, raisins or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines.
When eating vegetables, choose broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green and wax beans, lettuce, onion, peppers, watercress, zucchini, and yellow squash. Limit or avoid asparagus, avocado, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, and cooked spinach.
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Iron and Anemia
People with advanced kidney failure also have anemia and usually need extra iron. Many foods contain extra iron (liver, beef, pork, chicken, lima and kidney beans, iron-fortified cereals).
The Importance of Home-Prepared Meals
In general, eating at home offers significant benefits, especially when you’re trying to cut back on sodium. The trick is finding natural foods that you enjoy and avoiding processed snacks and frozen meals. By picking out and preparing food yourself rather than grabbing takeout or heading to a restaurant, you can save money and improve your health. Learning to prepare meals at home rather than eating out gives you better control over what you’re eating but requires paying careful attention to food labels at the grocery store.
Flavoring Food Without Salt
Avoiding sodium doesn’t have to mean bland food. Find tasty ways to pump up the flavor of your foods without adding sodium. Most other herbs are safe, and you can use them to flavor your food instead of salt.
Carbohydrates
If you do not have a problem eating carbohydrates, these foods are a good source of energy. If your provider has recommended a low-protein diet, you may replace the calories from protein with: Fruits, breads, grains, and vegetables. These foods provide energy, as well as fiber, minerals, and vitamins. Hard candies, sugar, honey, and jelly. If needed, you can even eat high-calorie desserts such as pies, cakes, or cookies, as long as you limit desserts made with dairy, chocolate, nuts, or bananas.
Managing Calcium and Phosphorus Levels
The minerals calcium and phosphorous will be checked often. Even in the early stages of CKD, phosphorous levels in the blood can get too high. This can cause: Low blood calcium, which causes the body to pull calcium from your bones, which can make your bones weaker and more likely to break, and Itching. You will need to limit the amount of dairy foods you eat, because they contain large amounts of phosphorous. This includes milk, yogurt, and cheese. Some dairy foods are lower in phosphorous, including: Tub margarine, Butter, Cream, ricotta, brie cheese, Heavy cream, Sherbet, and Nondairy whipped toppings. You may need to take calcium supplements to prevent bone disease, and vitamin D to control the balance of calcium and phosphorous in your body. Ask your provider or dietitian about how best to get these nutrients. Your provider may recommend medicines called "phosphorous binders" if diet changes alone do not work to control the balance of this mineral in your body.
Fluid Intake
In the early stages of kidney failure, you do not need to limit the fluid you drink. But, as your condition gets worse, or when you are on dialysis, you will need to watch the amount of liquid you take in. In between dialysis sessions, fluid can build up in your body. Too much fluid will lead to shortness of breath, an emergency that needs immediate medical attention. Your provider and dialysis nurse will let you know how much you should drink every day. Keep a count of foods that contain a lot of water, such as soups, fruit-flavored gelatin, fruit-flavored ice pops, ice cream, grapes, melons, lettuce, tomatoes, and celery. Use smaller cups or glasses and turn over your cup after you have finished it.
Tips to keep from becoming thirsty include: Avoid salty foods. Freeze some juice in an ice cube tray and eat it like a fruit-flavored ice pop (you must count these ice cubes in your daily amount of fluids). Stay cool on hot days