Navigating Cheese Choices on a Renal Diet: A Comprehensive Guide

Living with chronic kidney disease (CKD) requires careful attention to diet, and cheese, a beloved food for many, often comes under scrutiny due to its sodium and phosphorus content. However, with the right knowledge and choices, cheese can still be part of a kidney-friendly diet. This article provides a detailed guide to understanding cheese and its place in a renal diet, offering practical tips and recommendations for making informed decisions.

Understanding the Renal Diet

A renal diet is a dietary approach designed to manage the levels of electrolytes, minerals, and fluids in the body when you have CKD or are on dialysis. Limiting sodium is key for every stage of CKD. The best foods for you will depend on the stage of CKD you’re in, blood work results, and other health conditions. It typically involves limiting sodium, potassium, and phosphorus intake, while ensuring adequate calorie and protein consumption. The specific requirements of a renal diet vary depending on the stage of CKD and whether or not the individual is on dialysis. Registered Dietitians (RD) are invaluable resources for creating personalized dietary plans.

The Role of Sodium, Potassium, and Phosphorus

When the kidneys work right, they prevent too much potassium and phosphorus from building up in the blood. But with kidney disease, the kidneys may have trouble keeping these nutrients at healthy levels.

• Sodium: Sodium is found in salt and food additives. A healthy diet contains less than 2,300 milligrams of sodium a day. Many people eat more than that due to the sodium additives in pre-prepared, processed foods, and restaurant foods. High sodium intake can lead to high blood pressure and fluid retention, both of which can exacerbate kidney problems.
• Potassium: 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. Potassium is found in many fruits and vegetables, and excessive intake can lead to dangerous heart rhythms in individuals with CKD.
• Phosphorus: 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. Phosphorus is abundant in dairy products, and high levels can lead to bone disease and other complications.

Cheese and the Renal Diet: A Balancing Act

Many cheeses are high in phosphorus and sodium, but some are suitable for kidney disease. Cheese can be a good source of calcium, protein, vitamin B12, and vitamin A, and phosphorus. Some cheeses may contain probiotics or “good” bacteria to improve digestive health, including Swiss, Gouda, Gruyere, cheddar, and cottage cheese. Cheese can be eaten alone for a delicious treat, prepared as a dip, or enhance the flavor of your favorite dish. The key is to make informed choices about the types and quantities of cheese consumed.

Identifying High-Sodium Cheeses to Avoid

The following is a list of foods that are high in sodium. Cheeses, such as processed cheese spreads, easy melt cheese, American, and nacho cheese. In general limiting hard and processed cheeses will help keep sodium intake down. It's crucial to be aware of cheeses that are particularly high in sodium. These include:

Read also: Easy Low-Carb Cheese Crackers

• Processed Cheeses: Cheese spreads (such as Dairylea), processed cheese slices eg American cheese slices. Processed cheeses, such as processed cheese spreads, easy melt cheese, American, and nacho cheese. These cheeses often contain high levels of sodium and phosphate additives.
• Hard Cheeses: Most are moderate to high in salt (except Emmental). All are high in phosphate and some may also contain additives. The higher salt varieties should only be eaten occasionally and a small portion is recommended. Hard cheeses like cheddar, Parmesan, and Gouda tend to be higher in sodium than softer varieties.
• Salty Cheeses: Cheeses like feta, halloumi, and blue cheese (Gorgonzola, Danish Blue) are naturally high in sodium.

Low-Sodium and Low-Phosphorus Cheese Options

While many kinds of cheese are high in phosphorus and sodium, there are lower phosphorus and sodium cheeses more suitable for people with kidney disease. There are varieties on the market that are lower in phosphorus. Cheese is also known to be high in sodium. But just as with phosphorus content, there are varieties that are lower in sodium. Fortunately, several cheese varieties are lower in sodium and phosphorus, making them suitable choices for a renal diet. These include:

• Soft Cheeses:
  • Ricotta: Ricotta cheese is among the lowest in sodium (35 to 200 mg per ounce).
  • Cream Cheese: Brie, cream cheese, goat cheese (soft), natural sharp cheddar, natural Swiss cheese and ricotta are among the lowest in sodium (35 to 200 mg per ounce).
  • Cottage Cheese: Cottage cheese can be an easy and tasty snack.
  • Mascarpone: An excellent option as this type of cheese is low in salt. It also has lower amounts of phosphate than other cheeses and typically contains minimal or no additives so is a good option if you are on a low phosphate diet.
  • Paneer: An excellent option as this type of cheese is low in salt. It also has lower amounts of phosphate than other cheeses and typically contains minimal or no additives so is a good option if you are on a low phosphate diet.
  • Quark: An excellent option as this type of cheese is low in salt. It also has lower amounts of phosphate than other cheeses and typically contains minimal or no additives so is a good option if you are on a low phosphate diet.
• Semi-Soft Cheeses:
  • Mozzarella: This type of cheese can be a good option though it varies in salt with mozzarella having the lowest salt content. Most are lower in phosphate compared to other cheeses and usually have minimal additives.
• Hard Cheeses (in moderation):
  • Natural Swiss Cheese: Brie, cream cheese, goat cheese (soft), natural sharp cheddar, natural Swiss cheese and ricotta are among the lowest in sodium (35 to 200 mg per ounce). This cheese an excellent option as this type of cheese is low in salt. It also has lower amounts of phosphate than other cheeses and typically contains minimal or no additives so is a good option if you are on a low phosphate diet.

Plant-Based Cheese Alternatives

Plant-based cheese (made from nuts, seeds or starches) are typically high in salt and saturated fat (due to coconut oil). If you follow a vegan diet, then check the nutrition label and opt for the one with the lowest salt content, being mindful of portion sizes. For individuals seeking dairy-free options, plant-based cheeses made from nuts, seeds, or starches are available. However, it's essential to check the nutrition labels, as these alternatives can be high in sodium and saturated fats.

Practical Tips for Incorporating Cheese into a Renal Diet

Here are some practical tips to help you include cheese in a kidney-friendly way!

1- Choose lower salt and lower phosphate options. Choose cheeses that are lower in both salt and phosphate (if you are on a low phosphate diet). Salt is sometimes listed as ‘sodium’ on the nutrition label and you can compare different cheeses in this way to find lower salt options. The table below can give you a head start in helping you decide. Choose low salt options to have the majority of the time you eat cheese. Eat moderate and high salt options occasionally and always in smaller quantities. If you are on a low phosphate diet, choose those that contain low or medium amounts of phosphate and avoid all those with high phosphate or phosphate additives.Low Phosphate(less than 0.2g per 100g)Medium Phosphate (between 0.2-0.3 g per 100g)High Phosphate(more than 0.3g per 100g)Low Salt(less than 0.3g per 100g)RicottaMascarponeQuarkPaneerSwiss (Emmenta)lMedium Salt (between 0.3-1.5g per 100g)Cottage cheeseCream cheeseMozzarellaBrieWensleydaleHigh Salt(more than 1.5g per 100g)CamembertWhite StiltonFetaGoats cheeseBlue StiltonDanish BluePort SalutRoquefortDouble GloucesterRed LeicesterGoudaCheddarEdamHalloumiGruyere*Cheese spreadParmesan*Processed cheese*contains phosphate additives so recommended to avoid

2- Be mindful of portion sizes. If your favourite cheese is less kidney-friendly then we recommend a 30g serving (about the size of a matchbox) to help manage salt and phosphate. However, if choosing more kidney-friendly options, then you can have a larger portion.

Read also: Sweet and Savory Keto Cream Cheese

3- Make cheese go a long way. Choosing stronger flavoured cheeses, such as extra mature cheddar over mild cheddar, can be a good option to get extra flavour using a smaller amount. Grating cheese over dishes is another good way to enjoy their taste without overloading on salt or phosphate.

4- Watch your frequency. Less kidney-friendly cheeses can still be enjoyed if you have CKD - just don’t have them all the time! If you are not on a low phosphate diet, eating 30g of any non-processed cheese twice a week will be fine. You may be able to have more depending on your individual dietary habits.

• Read Food Labels: Remember, reading food labels is one of the best ways to know how much sodium you are getting. 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. Pay attention to sodium and phosphorus content per serving. Aim for cheeses with less than 10% Daily Value (DV) of sodium per serving. Be aware that food labels aren’t required to list potassium, so knowing which foods are high or low in potassium is beneficial.
• Control Portion Sizes: If your favourite cheese is less kidney-friendly then we recommend a 30g serving (about the size of a matchbox) to help manage salt and phosphate. However, if choosing more kidney-friendly options, then you can have a larger portion. Stick to small servings (e.g., 1 ounce) to manage sodium and phosphorus intake.
• Choose Strong Flavors: Choosing stronger flavoured cheeses, such as extra mature cheddar over mild cheddar, can be a good option to get extra flavour using a smaller amount. Grating cheese over dishes is another good way to enjoy their taste without overloading on salt or phosphate. Opt for cheeses with strong flavors, such as sharp cheddar or Parmesan, to use smaller amounts without sacrificing taste.
• Limit Frequency: Less kidney-friendly cheeses can still be enjoyed if you have CKD - just don’t have them all the time! If you are not on a low phosphate diet, eating 30g of any non-processed cheese twice a week will be fine. You may be able to have more depending on your individual dietary habits. Enjoy less kidney-friendly cheeses in moderation, perhaps once or twice a week.
• Pair with Kidney-Friendly Foods: Combine cheese with foods that are naturally low in sodium, potassium, and phosphorus, such as fresh vegetables or low-sodium crackers.
• Prepare Homemade Dishes: Homemade dishes are best for dessert, such as fruit-based pies or cobblers, cheesecake, and cookies. Avoid desserts made from boxed mixes or that contain mostly chocolate. Prepare homemade dishes using low-sodium cheese and other kidney-friendly ingredients.

Kidney-Friendly Macaroni and Cheese Recipe

Who doesn’t love a bowl of hot comforting creamy macaroni cheese? Try our low salt kidney-friendly version - it’s the perfect midweek dinner!

Serving size: 4

Ingredients:

Read also: Cottage Cheese Keto Guide

• 200g macaroni (dried)
• 2 tbsp of rapeseed oil
• 2 tbsp of flour
• 1 tsp dried mustard powder
• ¼ tsp garlic granules
• Ground pepper to taste
• 1 cup of milk (or plant-based alternative)
• 2 tbsp nutritional yeast*
• 30g mozzarella
• 30g cream cheese
• 1 tbsp of chopped chives

*Nutritional yeast is dried nutritional yeast flakes. It is an excellent low-salt and vegan replacement for strong tasting hard cheeses such as Parmesan due to its cheesy flavour. You can sprinkle it over foods and it is an excellent source of B vitamins.

Directions:

1. Cook the macaroni according to instructions and drain when finished.
2. Whilst cooking the macaroni, make the white sauce. Place the rapeseed oil in a saucepan and place on a low heat.
3. Stir in the flour, mustard powder, garlic granules and black pepper using a wooden spoon. Keep stirring over a low heat until the mixture is smooth and starts to bubble.
4. Keep stirring as you add in the milk slowly, mixing it in as you go.
5. Once all the milk is added, keep stirring and bring the white sauce to the boil for one minute.
6. Stir in the nutritional yeast, then add the mozzarella and cream cheese until fully melted and incorporated.

The Importance of Professional Guidance

Ask your health care provider to refer you to a registered dietitian to help you with your diet for kidney disease. Some dietitians specialize in kidney diets. Your dietitian can also help you create a diet to fit your other health needs. A registered dietitian specializing in renal diets is an invaluable resource. They can provide personalized recommendations based on your individual needs and help you navigate the complexities of a kidney-friendly diet.

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