Food Labels and Chronic Kidney Disease – 7 Nutrients To Watch Out For!

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Food labels and chronic kidney disease (CKD). When you have CKD, it is of the utmost importance that you eat the proper nutrition. When you eat properly, you can actually slow down your progression of kidney disease, and you can delay or even prevent having to go on dialysis, depending on the cause of your disease. Also, when you have CKD, you filter out substances and electrolytes less efficiently. And so you really have to be careful because if you eat certain foods in excess, you can build up too many of certain electrolytes in your body, and it can cause your heart to go into an abnormal rhythm or even to stop. So yes, when you have CKD, proper nutrition is literally a matter of life or death.


What Is Chronic Kidney Disease, or CKD?

CKD is when you have kidney damage or a decrease in kidney function for at least three months. And there are many causes. The most common causes are diabetes, number one, and hypertension, number two. But you can also have different forms of inflammation of the kidney, things like lupus that can cause lupus nephritis.

You can also have FSG or IGA nephropathy. When you have CKD, it affects the way your body processes nutrition. Also, when you have this disease, you need particular nutrients in order to slow down the progression of your kidney disease and to try to prevent going on dialysis or needing a transplant. So that's what we'll talk about today I'll talk to you about how to read your nutrition facts labels when you have CKD.


food labels and chronic kidney disease

How To Read Food Labels When You Have Chronic Kidney Disease: 7 Nutrients To Watch Out For!

So let's talk about food labels and chronic kidney disease.  I'm Dr. Frita, an M.D. and board-certified nephrologist, which is the study of kidneys and high blood pressure. And today, we're going to talk about how to read food labels, especially when you have CKD. Here are 7 nutrients that you should definitely watch out for!


1. Sodium or Salt

Eating salt in excess can worsen the disease. When you have too much salt in your diet, it can worsen high blood pressure, which is the second leading cause of patients going on dialysis or needing a transplant. Also, if you eat salt in excess and you have CKD, it can cause you to retain fluid. And if you retain too much fluid, it can lead to a buildup of fluid in the lungs, or pulmonary edema, which can cause you to have breathing problems or even respiratory failure.

It is recommended that most patients with CKD have less than two grams, or 2,000 milligrams, of sodium each day, but not less than 1,500 milligrams. Some organizations, like the American Heart Association, have even stricter recommendations and recommend less than 1.5 grams of sodium per day, or 1,500 milligrams of sodium. Be sure to consult with your physician.

Be A Label Watcher!

In order to avoid excess sodium, you want to be a label watcher. You want to read those food labels and you will see the salt listed as sodium. And so you want to look at the milligrams, or mg, and make sure when you go throughout your day, you try to stay under that 2,000 milligrams or even 1,500 milligrams. And remember, even in foods around the house or in foods that you cook there may be salt added, so you want to be cognizant of that.

Avoiding fried foods, chips, and pre-packaged foods are ways to help to reduce your sodium intake. Be sure to watch my video on 10 low-sodium foods to eat when you have high blood pressure after you finish reading this article.

how to read food labels when you have ckd

2. Phosphorus

Phosphorus is a nutrient that can actually be good for your bones. It can help you to maintain healthy and strong bones. But when you have CKD, you tend to excrete phosphorus less. You don't get rid of the phosphorus the way that you should, and you develop hyperphosphatemia or elevated phosphorus in the blood. Now, when this happens, you can also develop an elevated PTH, or parathyroid hormone, which can lead to weak bones and increase your risk for bone fractures.

Elevated phosphorus can also cause issues with cardiovascular disease, and it can create really uncomfortable itchy skin when you have high phosphorus. People with CKD who have an EGFR of less than 60 (estimated glomerular filtration rate of less than 60), should limit their phosphorus intake to anywhere from 800 milligrams to 1,000 milligrams per day. Be sure to consult with your physician and your renal dietician to be sure what phosphorus level is right for you.

How Can You Limit Your Phosphorus?

Read the food labels. When you get your food, you want to look and see how many milligrams of phosphorus it contains. And again, if you have CKD, you want to make sure you keep it between 800 to 1,000 milligrams if you have CKD stage three. And if you have more advanced kidney disease, you may need to limit your phosphorus to less than 800 milligrams.

Now, if your CKD is very advanced, like if you have CKD stage four or CKD stage five, then you may actually need Phosphate/Phosphorus binders. And these are medicines that you take at the same time that you eat that will actually bind to the phosphorus and keep it from being elevated in your blood.

Foods To Avoid If You're Trying To Limit Your Phosphorus Intake

If you're trying to limit your phosphorus intake you should avoid milk, cheese, chocolate, and ice cream. Everything is in moderation. But you definitely want to be a label watcher in order to watch out for phosphorus in your diet if you have it.


3. Potassium

You definitely have to watch out for potassium if you have CKD. Potassium is an electrolyte that's really good in that it helps you to have normal heartbeats. It can also help you with muscle contraction and relaxation. However, when you have CKD, especially advanced CKD, you don't filter out the potassium the way that you should, and you can get excess levels in your blood. When this happens, you get high levels of potassium in your blood, then it can lead to abnormal heartbeats or arrhythmias. It can even cause your heart to stop. And so it's very important to be aware of your level of CKD and to know how much potassium you should have in your diet.

For most people who do not have CKD, potassium intake can range anywhere from two to five grams per day. It is recommended that most adults have 4.7 grams of potassium per day. If you have CKD, however, you want to limit your potassium intake. Certainly, if you have progressed to CKD stage three or beyond, you want to limit that potassium intake to about two grams per day. Again, consult with your nephrologist and your renal dietician to find out what level of potassium is right for you. Because even if you don't have a very advanced level of CKD, if you're on certain medications that may increase the potassium in your blood, like ACE inhibitors, ARBs, and spironolactone, then you may also need to limit your potassium.

Watch Serving Sizes

The best way to watch out for potassium is to read those food labels. Again, look and see how many milligrams of potassium are in your serving of food. And make sure you look at the serving size because a lot of times these serving sizes are smaller than what you think they should be. So multiply it out. If you're eating a whole pack of something and it says that it has four servings in it, and you look at the potassium and say, "Oh, it only has 200 milligrams per serving," if you've eaten the whole package, make sure you multiply that out by four so you know just how much potassium you're taking in.

foods that at high in potassium

You also want to avoid certain foods that have high potassium if you have CKD. Foods like bananas, tomatoes, oranges, avocados, spinach, kiwi, and nectarines. Yes, I know those sound good. Again, everything in moderation. Consult with your physician. But if you have CKD, potassium is a nutrient you need to watch out for.


4. Protein

You'll want to keep an eye on your protein intake because if you have excess protein with kidney disease, it can hasten the progression of the disease. It can lead you to dialysis faster. Also, if you have a protein intake that is too high, then it can cause you to have an increased acid load. It can make your blood more acidic or have a low pH.

You know how you can see alkaline water being sold at grocery stores, or people are talking about how being alkaline is more healthy? Well, yes, if you eat excess protein and you have CKD, your body can be the opposite of alkaline, and you can be acidic, which is not healthy for you. When you have excess protein with CKD, you can also increase the toxins or the poisons in your body. You can make that BUN number, your lab blood urea nitrogen, too high.

How Much Protein Should You Have?

Generally, if your EGFR is less than 30, you should start restricting your protein to 0.6 to 0.8 grams per kilogram of your body weight. So that usually averages about 60 to 80 grams of protein daily for most people. Consult with your physician. In order to watch out for the protein, again, you need to read labels. When you eat something, look at the label. Look at how many milligrams or how many grams of protein it has, and try to make sure that you stay within that 60 to 80 grams per day if you have CKD and if your doctor has instructed you to do so.

Now, if you have nephrotic syndrome, or if you're someone who is spilling an excessive amount of protein, then your protein restriction may be different. Also, if you've already progressed to end-stage renal disease and you're on dialysis, you also may have a different protein restriction. In other words, you may need to actually eat more protein. But in general, for patients who have CKD, who are not on dialysis, and who do not have nephrotic syndrome, you want to restrict that protein to 0.6 to 0.8 grams per kilogram of body weight.

how much protein is in meat and seafood

How Much Protein Is In Meat and Seafood?

Now, I told you how to read the labels, but what if you're eating things like meat, fish, or salmon? How are you supposed to know how much protein is in these meats and seafood? Well, the average piece of salmon, if you think about an ounce of salmon, it has about six grams of protein per ounce. So if you're having a nice little filet of a six-ounce piece of salmon, that's 36 grams of protein. And if you're eating a serving of white meat chicken with no skin, (that's about the size of the palm of your hand), that's going to be about four ounces. And four ounces of chicken is about 35 grams of protein.


5. Calcium

Calcium is actually the most abundant mineral in the body. And 99% of the calcium in your body is in your bones and your teeth. So you definitely want to make sure you have good calcium levels in order to have nice teeth and strong bones. When you have CKD, however, you can have various issues with your calcium. Some patients with advanced CKD can have low calcium, especially because your calcium absorption is regulated by vitamin D, and your vitamin D is activated by healthy kidneys. If you don't have proper vitamin D and you're not absorbing the proper amounts of calcium with CKD, then you can have low calcium, and you may need to have supplementation.

Patients with CKD can also have high calcium, especially if they are someone with an advanced illness, and tend not to move around very much. If you're immobile, that can lead to high calcium or hypercalcemia. Also, if you have issues with your PTH, the parathyroid hormone, that can lead to abnormal calcium. You will have to consult with your physician to find out your calcium level. Ask your physician to check your calcium, your albumin, and your ionized calcium if your calcium is abnormal.

Now, for people who don't have kidney disease, people in the general healthy population, about 1,000 milligrams of calcium is usually sufficient, but again, if you have CKD, you need to talk with your doctor and your renal dietician to find out the level of calcium that is right for you. And once you find out, watch those labels so you're not taking in the wrong amount.


6. Vitamin D

Vitamin D is another nutrient you need to watch out for when you have CKD because many people with chronic kidney disease will have low vitamin D because healthy kidneys are responsible for activating vitamin D. If you don't have kidneys that are as healthy as they should be, then you won't be able to activate vitamin D, and you can end up with vitamin D deficiency. Now, vitamin D is not only responsible for regulating calcium absorption and phosphorus and helping you to have strong bones, but it also can aid in your immunity.

Vitamin D acts more like a hormone than a vitamin because it's essential for you to have proper health. A healthy range of vitamin D for most people is considered to be at least between 40 and 80 milligrams per milliliter. If your doctor checks your vitamin D level, that vitamin D 25-OH level, and they find that it is less than 30, then very likely they will give you a once-weekly vitamin D, like an ergocalciferol. Again, consult with your physician.


Daily Recommended Vitamin D

For most people, the daily recommended vitamin D is 2,000 IUs or international units. However, if you are taking vitamin D under the guidance of your physician, you can likely take much more than that, 5,000, or even more IUs, as long as you have a physician who is monitoring your vitamin D levels to keep you from getting vitamin D toxicity.

Foods That Are High In Vitamin D

Foods that are high in vitamin D include fatty fish, like salmon, mackerel, and sardines. If you have CKD, again, depending on your level, you may be put on a vitamin D supplementation.


7. Iron

Iron is another important nutrient you want to be careful of when you have CKD because many patients with kidney disease have low iron, and that can make you anemic or have low blood. So iron is a mineral that's very important because it helps to build your hemoglobin, which is in your red blood cells, and your red blood cells carry oxygen to all of your tissues.

When that iron is low, you become anemic or have low blood, and you can feel tired, and fatigued, and have a high heart rate or low energy, and you can even have an increased risk for a heart attack if you are very anemic. Most healthy people should eat about eight milligrams of iron per day. If you're between the ages of 18 and 49, you should take in about 18 milligrams of iron per day. But certainly, you want to consult with your physician because if you have iron deficiency, you may be put on iron supplementation. And if it's extremely low, you may actually have to have iron injected or have IV iron infusions.

High Iron Foods

Foods that tend to have high iron are meats. And actually, the Heme iron, or the iron that you get from animal products, is absorbed more easily than non-heme iron, or the iron that you get from plant-based foods. However, you can get better absorption even if you are a vegetarian or a vegan from plant-based iron if you take in vitamin C.

high iron foods

And foods that are rich in vitamin C and are also kidney safe include strawberries, pineapples, and cauliflower. So yes, watch those food labels, and see how many milligrams of iron you have in foods, especially if you're iron deficient. You want to bump up the iron intake. And as always, consult with your physician.



So these are seven of the nutrients that you should really pay close attention to if you are a person with CKD or the symptoms of chronic kidney disease. You want to be sure to be a label watcher. Pay attention to the serving sizes. And make sure that you avoid those nutrients that may cause your kidney disease to progress or get worse. And you want to make sure you take in all of the nutrients that will help you to sustain healthy kidneys and try to prevent going on dialysis.

If you have advanced kidney disease and you are already on dialysis, or even if you've had a transplant, it is still always important to read your food labels - "be a label watcher" and to pay attention to the nutrients that will help your body.

Dr. Frita - Frita McRae Fisher, M.D.
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