For individuals managing kidney disease, dietary choices play a crucial role in maintaining overall health and slowing disease progression. Milk, a staple in many diets, often raises questions regarding its suitability for those with kidney conditions. This article explores the complexities surrounding milk consumption and kidney disease, providing guidance on selecting kidney-friendly milk options, including plant-based alternatives.
Dairy and Kidney Disease: A Complex Relationship
Many of us were encouraged as children to drink milk to grow strong and maintain healthy bones. The USDA recommends 2-3 servings of dairy per day depending on age, weight, and sex for a healthy diet. Cow's milk provides essential nutrients, including protein, calcium, vitamin D, and various other vitamins and minerals.
However, for individuals with kidney disease, the recommendation is to limit dairy products like milk to just 4-8 ounces per day. This recommendation is because milk is rich in minerals, including phosphorus and potassium. When kidneys are not functioning optimally, they become less efficient at removing excess phosphorus and potassium from the body, especially as kidney disease progresses.
Minerals in Milk: Phosphorus, Potassium, and Calcium
Phosphorus: High phosphorus levels in the blood are a common concern for individuals with chronic kidney disease (CKD). Milk is a significant source of phosphorus, and excessive intake can lead to weakened bones and hardening of blood vessels.
Potassium: The kidneys play a vital role in regulating potassium levels. Impaired kidney function can lead to potassium buildup, potentially causing hyperkalemia, a dangerous condition affecting muscle and heart function.
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Calcium: Calcium is another mineral found in milk. Some people with kidney disease need to limit calcium-rich foods, while others benefit from having more. If you suffer from kidney stones, specifically calcium oxalate stones, getting enough calcium can prevent the formation of kidney stones. The same is true for those with polycystic kidney disease (PKD). Adequate calcium intake can prevent crystals from forming in the kidneys, which help to prevent disease progression.
Fat Content in Milk: Does It Matter?
Although higher fat content milk has slightly fewer minerals, the difference is not significant. All types of milk are high in potassium and phosphorus and are a good source of calcium.
Plant-Based Milk Alternatives: A Kidney-Friendly Option?
Cutting back on milk is one of the hardest things about following the renal diet. Luckily, there are endless options of plant-based milk alternatives available at the grocery store today! But not all are created equal, and knowing which type of milk is best for you can be a wild ride.
Plant-based milk alternatives have become increasingly popular, offering a diverse range of options for those seeking to reduce or eliminate dairy from their diet. These alternatives are derived from various sources, including rice, soy, almonds, coconut, oats, and cashews. However, it's crucial to recognize that not all plant-based milks are created equal, and careful consideration is necessary when selecting the most appropriate option for a kidney-friendly diet.
Label Reading: The #1 Rule for Plant-Based Dairy Products
Plant-based milk and dairy products do not have the same nutritional profile as cow's milk but are often enriched with vitamins and minerals to make them a more comparable substitute. When fortifying plant-based milk, food manufacturers commonly add potassium and phosphorus - two minerals to look out for if you have kidney disease.
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"PHOS" in Plant-Based Milks
Phosphorus (or what we lovingly call PHOS) is naturally found in almost all milk alternatives. For example, almond milk, rice milk, and soy-milk contain about 20 mg, 50 mg, and 80-150 mg of phosphorus per cup, respectively. Not too shabby compared to the 250 mg found in cow's milk! However, the big concern is that phosphorus is often added to alternative milk. Phosphorus that is added to food is also known as inorganic phosphorus or phosphorus additives. The problem with inorganic phosphorus is that it's much easier for our bodies to absorb than phosphorus naturally occurring in food, like milk. Phosphorus is not typically found in the "nutrition facts" part of the food label. The best way to know if phosphorus has been added to food is to check the ingredients list. There are numerous common phosphorus additives in alternative milk. A few examples include:
- Tricalcium phosphate
- Dipotassium phosphate
- Magnesium phosphate
The easiest way to know if phosphorus is added is to check for "P-H-O-S" embedded in the ingredients.
Potassium in Alternative Milks
The potassium content of plant-based milk varies. While some plant-based milk options naturally contain more potassium, others have very little. Fortunately, potassium is now listed on the Nutrition Facts label, so there is no question about how much potassium is packed into an 8-ounce glass of your favorite milk! You might also notice the increased use of potassium additives in plant-based milk. Potassium additives may go by the names:
- Potassium citrate
- Dipotassium phosphate
Studies show that foods with potassium additives contain more potassium than the same food without potassium added. It's important to remember that not everyone with kidney disease needs to limit potassium. However, if you do, check the label for the amount of potassium in the nutrition facts label and the ingredient list for any potassium additives.
Kidney-Friendly Plant-Based Milk Alternatives to Consider
The variety of different types of plant-based milk alternatives has grown immensely over the years. There are lots of reasons why consumers have been leaning into plant-based dairy options. For some, it may be due to health reasons such as milk allergy or intolerance. For others, it may be due to concerns about the hormones or saturated fat found in milk. In addition, many people are choosing to eat a more plant-based diet for environmental reasons or because they do not consume any animal products at all. No matter the reason, consumer demand for plant-based milk options is growing.
Read also: Comprehensive Guide to Renal Diet Meals
Let's review the most popular choices on the market today and the considerations for a kidney-friendly diet!
1) Rice Milk:
Rice milk is one of the original plant-based milk options available on the market. A key benefit is that rice is not a top allergen and does not contain lactose. Therefore, it's an excellent option for people with an allergy to milk, soy, or lactose intolerance. Because rice milk is naturally low in potassium, phosphorus, and protein, it becomes an excellent choice for people with kidney disease.
2) Soy Milk:
The amount of potassium in soy milk varies by brand but averages about 400 mg per 8-ounce serving, while phosphorus can range anywhere from 80 mg- 250 mg. Soy milk is one of the highest protein plant milk. It contains about the same amount of protein as cow's milk per serving, making it an excellent plant-based milk option for individuals on dialysis and those with CKD and Diabetes because of higher protein needs. Plain soy milk is also low in oxalates, at only 4 mg oxalates per cup. This makes soy milk kidney-friendly, even for those with PKD. However, if potassium and phosphorus are a concern, choosing a lower potassium and phosphorus plant-based milk may be best.
3) Almond Milk:
Almond milk is an excellent option for people with CKD because it is naturally lower in potassium and phosphorus. Potassium in almond milk is only 75 mg per cup, while phosphorus in almond milk is 73 mg per cup. To ensure that you choose the best almond milk, we recommend checking the label for those pesky phosphorus additives. It's also very low in protein, making it perfect for those following a low- or very low-protein diet. If you are limiting calcium in your diet, be aware that some brands of almond milk are fortified with up to 500 mg per serving! One final note: almonds are HIGH in oxalates. If you have PKD or are at risk of kidney stones, you may want to avoid almond milk. Other than that, almond milk is good for kidney patients.
4) Coconut Milk:
Coconut milk can get a bit confusing because it comes in two different forms:
- Canned coconut milk: Fresh coconut mixed with just a little water is full of fat and deliciously creamy! Canned coconut milk is typically used for cooking and because it's full of fresh coconut it contains about 300 mg of potassium per 1 cup serving. Fortunately, with canned coconut milk a little goes a long way to get that creamy coconut flavor.
- Coconut milk beverage: Has more water added to ensure a thinner consistency more akin to milk. It is typically much lower in potassium but always check the label to be sure.
Coconut milk is keto friendly because it is naturally high in fat and low in sugar. It is also very low in oxalates, making it a perfect choice for those with PKD and/or are at risk of kidney stones. If you're looking for a kidney-friendly alternative to milk, coconut milk beverage is the way to go. Many options are available, but finding the right one can be tricky because many products contain phosphorus additives.
5) Oat Milk:
Oat milk is one of the dairy-free newcomers on the block but is increasing in popularity. One of the things that people love about it is the creaminess and that it is allergy-free. Oat milk is higher in carbohydrates (usually around 20 grams) and protein (approximately 4 grams) compared to many other milk alternatives. Many of the oat milk products available are also packed with sugar. The potassium in oat milk varies depending on the brand. If potassium is a concern for you, always check the label or discuss with your KNI dietitian for more help. Also, remember to check the label for phosphorus additives because they are used widely in most oat milk options! If you are hoping to get a source of calcium from oat milk, we have not yet found a brand that does not have calcium added without phosphorus.
6) Cashew Milk:
Cashew milk is another plant-based milk made from nuts, though not nearly as popular as almond milk. Nevertheless, it is a deliciously creamy option that works well as a topper for cereal or in your morning cup of coffee. Only a few brands of cashew milk are available right now; however, you can find many that have blended cashew milk with other types of milk. Cashews are chock full of heart-healthy monounsaturated fats and minerals like iron, magnesium, zinc, and copper. Unfortunately, much of this can get lost in the process of making cashew milk. If you are watching your oxalate intake, please note that cashews are naturally high in oxalates. Most cashew milk products contain 150 mg of potassium or less, making it a good choice when limiting potassium. Always check the label for phosphorus additives.
Other Non-Dairy Milks
The plant-based milk options listed above are the most popular choices, but several other types of milk are available.
- Hemp Milk: Hemp milk is made from hemp seeds which are a great source of the two essential fatty acids, omega-3 and omega-6. Hemp seeds also contain minerals and small amounts of amino acids. Hemp milk can be an excellent option for those who have an allergy to nuts or soy. However, there are limited options available on the market.
- Flax Milk: Flax milk is made from flax seeds. Like hemp seeds, flax seeds are also a great source of Omega-3 fatty acids and fiber. Another benefit of flax milk is that it is nut-free, so it's great for people with allergies. Flax milk is naturally low in protein for those following a low protein or very low protein diet. However, if you need more protein, you can find flax milk with added pea protein. Flax milk is naturally low in potassium and oxalates, but sadly, the primary brand of flax milk available at most grocery stores contains phos additives.
- Pea Milk: Pea milk is one of the new kids on the block of plant-based milk alternatives. Derived from the humble yellow dried pea, it has many significant advantages over some of the other options on the market. Like soy milk, pea milk has the same amount of protein as cows milk, making it one of the highest protein plant milk available.
Key Considerations for Choosing Milk Alternatives
- Protein Content: Choose milk alternatives based on individual protein needs. Soy and pea milk are higher in protein, while almond, rice, oat, cashew, coconut, hemp, and flax milk are lower.
- Phosphorus Content: Scrutinize labels for phosphorus additives, as inorganic phosphorus is more readily absorbed.
- Potassium Content: Select milk alternatives with lower potassium levels if potassium restriction is necessary.
- Oxalate Content: Individuals with PKD or a history of kidney stones should be mindful of oxalate levels, particularly in almond and cashew milk.
- Added Sugars: Opt for unsweetened varieties to minimize added sugar intake.
- Calcium Fortification: Consider calcium fortification levels, especially if dietary calcium intake needs to be adjusted.
General Dietary Recommendations for Kidney Health
In addition to milk choices, a renal-friendly diet involves several key considerations:
- Limit Sodium: Reduce sodium intake to help control blood pressure and fluid retention.
- Balance Protein: Work with a dietitian to determine the appropriate protein intake level, as excessive protein can strain the kidneys.
- Avoid Processed Foods: Minimize consumption of processed foods, which are often high in sodium and phosphorus.
- Stay Hydrated: Drink adequate fluids to help the kidneys flush out waste products.
Consulting a Renal Dietitian
Navigating the complexities of diet and kidney disease can be challenging. Consulting a registered renal dietitian is highly recommended. A renal dietitian can provide personalized guidance based on individual needs, lab results, and disease stage, ensuring that dietary choices support kidney health and overall well-being.