The RenalTracker Team
May 26, 2021

Imagine walking to a grocery store, and you're planning to buy bread for tomorrow's breakfast. You see all your favorite bread products and when you're about to pick up a pack of whole wheat bread, you suddenly ask yourself, "Am I allowed to have this, knowing that I have kidney disease?" You're aware that your kidneys are not functioning as they used to, so in moments like this, you think and wonder about the ingredients that can potentially exacerbate your CKD. Likewise, you then keep asking yourself the question, “what breads are good for my kidneys?"

There are certain nutrients that CKD patients should be cautious about...

Kidneys filter excess fluids and waste from the blood and are expelled into the urine. CKD patients are often diagnosed with high levels, potassium, phosphorus, sodium, or protein in the blood system. As your kidney condition progresses, these minerals aren't used by the body correctly. In turn, the excess minerals remain as waste products in the blood.

Frequent consumption of bread with high levels of these minerals may lead to waste buildup that can harm your kidneys. On top of that, some bread products have high-fat ingredients and sugar that can be harmful to diabetic CKD patients. 

In this article, we will talk about bread ingredients and bread products to guide you through your breakfast selection.

What are the baking ingredients and products should you watch out for as a CKD patient?

Surprisingly, the following ingredients are usually found in common bread products. 

1) Self-rising flour

It is used in baking "quick bread" and is a mixture of all-purpose flour, salt, and baking powder. Salt contains sodium, while baking powder contains phosphorus and that is what we should be cautious in eating. Self-rising flour is used in baking products such as: 

  • Quickly baked muffins (some contain high amounts of sugar and sodium)
  • Banana bread (also contains potassium because of the banana)
  • Scones
  • Cornbreads
  • Quick loaf bread

2) Wheat flour

The more bran and whole grains used in baking bread, the higher phosphorus and potassium are in bread. Bread examples that use wheat flour and high amounts of bran are the following:

  • Multi-grain bread
  • Whole wheat bread
  • Whole grain bread with nuts/oats or both
  • Rye bread (which also contain significant amounts of sodium)

3) Unsalted butter and trans-fat free margarine 

Unsalted butter and trans-free margarine have less sodium, and bad cholesterol. Since butter and margarine are both made with saturated fats that can contribute to bad cholesterol, it is important to steer clear from these ingredients. 

Look for keywords in the ingredients list, such as "hydrogenated" and "semi/partially-hydrogenated" fats or oils. Hydrogenated fats or oils are liquid vegetable oils that may be chemically manipulated to turn into a semi-solid or solid fat, which could form into artificial trans fat. These trans fats raise the level of bad cholesterol and decrease the good cholesterol, disturbing the balance in your body. This imbalance has been linked to a range of lifestyle diseases such as stroke, heart disease, and type 2 diabetes. 

These ingredients are mostly found in processed custards, lard, and creamy sweet fillings. Watch out for flaky bread, cream filled bread or bread with butter-cream toppings

4) Sweet and savory breads 

Those with “sweet-tooth” should minimize their cravings for sweet and savory breads to manage the risk of diabetes. Diabetes is the leading cause of kidney disease, wherein 1 out of 3 diabetic adults has kidney disease. Bread toppings and ingredients such as chocolates and nuts are high in potassium and sodium. Additionally, while cinnamon can help regulate blood sugar, consuming cinnamon buns is another story as bread products such as this still contain high sugar levels. Consider consuming bread products that use natural sweeteners or sugar alternatives.

If you are buying from a local bakeshop, you can ask the baker the type of  flour, butter or margarine and how much salt they used in baking the bread. Remember: it's okay to ask these questions rather than cluelessly buy bread and base your choices on assumptions. For store-bought packed bread products, check labels for nutrition information and ingredients list before popping it on the counter. 

What should you check at the back of packed and processed breads?

Checking the nutrition facts label and the ingredients list is a key step in buying bread. This will provide you the necessary information in selecting kidney-friendly bread. 

1) Phosphorus 

Added phosphorus is used by manufacturers to improve taste or prevent discoloration.  Any ingredient that has "phos" in their name has added phosphorus. These are the examples:

  • Calcium phosphate
  • Disodium phosphate
  • Phosphoric acid
  • Monopotassium phosphate
  • Sodium acid pyrophosphate
  • Sodium tripolyphosphate

If they have any of these ingredients, check the DV% (daily value percentage). Aim for bread products with less than 5% daily value percentages of both potassium and phosphorus. 

2) Sodium 

Salt keeps the bread fresh and tasty. However, most CKD patients are encouraged to follow a low sodium diet to protect their kidneys from further damage. A high sodium diet can cause your kidneys to decline their function and remove less water that results in high blood pressure, shortness of breath and  swollen hands, feet, and legs. An increased blood pressure can put extra strain into the heart. 

Aim to buy bread products with less than 5% daily value percentages per serving. At times, the bread may have low contents of phosphorus and potassium but have high sodium content. Try choosing bread with less than 130 mg in it.

What are kidney-friendly breads you can eat?

1.) Bagels

A great way to start your day is with some bagels. These are chewy, dense pieces of bread with a browned and sometimes crispy exterior. They're perfect to partner with your hot cup of black coffee. 

Bagels, especially those that are homemade or freshly baked, can have lower potassium and phosphorus content and controlled sodium in them. But again, this depends on the supplier's choice of ingredients. So it is still better to mind your portion sizes and check the label.  

2.) White loaf bread slices

Instead of choosing bread baked with self-rising flour, white loaf bread slices are baked using white flour or all-purpose flour which is lower in phosphorus and potassium compared to wheat flour. 

Although they may seem bland, you can partner them with scrambled eggs or try doing an "Egg-in-a-hole", where you put a hole in a slice of white bread and break an egg in the middle while cooking it on a non-stick pan. 

3.) Herbed Italian bread, herbed loaves, low sodium garlic bread 

These come in different forms and sizes; they are usually aromatic because of the herbs and spices used in them! These bread products can be made with less salt, meaning lower sodium content. 

Alternatively, bakers can improve the taste of the products through the use of low sodium herbs and spices. 

Do all of these tips apply to those who have kidney disease?

Ideally, these tips can apply to all CKD patients to help manage their daily nutrient intake.  However, if you have elevated SPPP levels, you need to be extra cautious about your bread selection and your diet in general. Talk to your nephrologist about your lab results.

Also, check with your dietitian on the portion sizes you are allowed when eating bread. Low levels of potassium, sodium, and phosphorus in bread don't automatically mean that you should eat them frequently and abundantly! 


The Bottom Line

So, the next time you decide to have bread for breakfast, remember to consider these notes and remember that eating is not just to feel full, but it is a way to help and nourish the body -- with the right amount of nutrients through proper food choices and portion sizes.

Sources:

Baking on Kidney Diet; Davita Kidney Care-
https://www.davita.com/diet-nutrition/articles/advice/baking-on-the-kidney-diet

Choosing a Bread that will Fit the Chronic Kidney Disease Diet: An Emphasis on Sodium and Phosphorus; K. Sheridan, RD -
https://www.jrnjournal.org/article/S1051-2276(12)00056-8/fulltext

Quick Breads Overview; B. Betti -
https://bakerbettie.com/quick-breads/


White Bread or Whole Wheat Bread on a Kidney Diet? Which Is Best?; M. Ford -
http://www.renaldiethq.com/white-bread-or-whole-wheat-bread-on-a-kidney-diet-which-is-best/


Best Breads For Chronic Kidney Disease and Dialysis Patients To Eat; Dallas Renal Group- 
https://www.kidneybuzz.com/best-breads-for-chronic-kidney-disease-and-dialysis-patients-to-eat


Low-phosphorus diet: Helpful for kidney disease?; R. Majorowicz -
https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/expert-answers/food-and-nutrition/faq-20058408


Diabetic Kidney Disease -
https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease


Hydrogenated Oils and Trans Fats -

https://www.thespruceeats.com/do-hydrogenated-oils-contain-trans-fats-2246050
https://www.healthline.com/nutrition/why-trans-fats-are-bad