Cheese is a versatile food that you can eat on its own, as a spread or as toppings. Whether it’s on burgers, pasta or with a glass of wine, cheese is a delicious addition to a range of snacks and dishes. More cheese is produced globally than the combined production of coffee, tea, tobacco, and cocoa beans. 20 million metric tons of cheese is produced annually, and the production continues to increase considering its growing demand.

When you have kidney disease, eating cheese can be challenging. Cheese is a great source of potassium, protein, and calcium – the nutrients that a CKD patient should watch over to avoid worsening their condition. As kidney function decreases, protein waste products, salt, and minerals can increase to unsafe levels since the kidneys can no longer filter waste as they used to. 

Cheese On a Renal Diet

Does cheese have a place in a CKD diet? CKD patients can still consume cheese, but it comes with a caveat. Since each CKD patient has different nutritional requirements, you need to check in with your renal dietitian to know how much and sodium, protein, potassium, phosphorus, (SPPP) you would need per day.

Cheese Nutritional Facts

As mentioned, cheese contains nutrients that a CKD patient should watch out for, such as:

Sodium in Cheese

Many people with CKD will not have symptoms at the early stages because the body can usually cope with the decline in kidney function. At this stage, kidney disease is often only diagnosed through a routine test for another health concern.

Too much sodium in the body can result in high blood pressure, edema (swollen face, hands, legs, and ankles), breathlessness, and heart failure. 

Cheese can have as much as 400 mg of sodium per ounce. During cheese production, salt is added to stop bacteria growth, control moisture, and improve taste and texture. Most importantly, salt is added to preserve the cheese.

People with CKD need to keep their sodium intake within 750 mg to 2,000 mg a day. Check-in with your nephrologist for your exact limit.  

Low Sodium Cheese Options

Cheeses marked “low sodium” at the grocery stores don’t necessarily meet your sodium requirements. It is because artificial ingredients are added to the cheese to compensate for the lack of salty flavor.

Nevertheless, these are “low sodium cheese options”:

1. Ricotta Cheese - 123 mg per 0.25 grams or a serving

Since ricotta cheese has a high moisture content, ricotta doesn’t need salt as preservatives or flavor. Add this neutral cheese to your pasta or salad. 

2. Cream Cheese - 48 mg per ounce

Bagels and cream cheese are a delicious breakfast combination. This cheese type doesn’t need additional salt to remove moisture from the curd or for preservatives.

3. Parmesan Cheese - 121 mg per 5 grams

The FDA serving for Parmesan is five grams, as most people use only use this cheese as an ingredient and not as a meal. 

4. Swiss Cheese - 56mg per ounce

One of the cheeses that has the lowest sodium content per serving is the Swiss Cheese. Swiss cheese is versatile, so you can enjoy it with almost anything. 

Phosphorus in Cheese

Since damaged kidneys cannot filter excess phosphorus from the body, too much phosphorus can lead to different health issues. Too much phosphorus in the blood -(hyperphosphatemia) can result in itchy eyes, nausea and diarrhea. It can also expedite the progression of kidney disease, which is why you need to check in with your dietitian about your phosphorus requirement.

How much phosphorus you need is dependent on your kidney function. If you have reduced kidney function and are not on dialysis treatments, you need to maintain serum phosphate at 0.87 to 1.49 mmol/L. 

Meanwhile, if you are undergoing dialysis you may need to keep the range from 1.13 to 1.78 mmol/L. Note: Some ranges may vary depending on what is used by the laboratory. For more info, check out our blog.

The body absorbs less phosphorus from natural food sources compared to processed foods. In terms of phosphorus absorption, cheese is closer to meat, which means the body absorbs 90% of its phosphorus content. All cheese has phosphorus with most of them containing between 120 to 150 milligrams per ounce. A few cheese types can have as much as 300 mg per ounce. 

A few of the highly processed cheeses include American Cheese (white & yellow), Velveeta Cheese, Canned Cheese, Nacho Cheese, and Macaroni and Cheese (box and powder)-- these are typically high in sodium too. 

Phosphorus can be organic or inorganic. Generally, cheese can have both organic and inorganic phosphorus content, which is why you must read the nutrition label. Inorganic phosphorus is 100 per cent absorbed by the body compared to organic phosphorus content. This means that consuming food sources rich in inorganic phosphorus can spike the phosphorus level in the blood.

You can spot inorganic phosphorus (phosphorus additives) on labels, as they can take the forms of:

• Calcium phosphate
• Dicalcium phosphate
• Disodium phosphate
• Monosodium phosphate
• Phosphoric acid
• Sodium acid pyrophosphate
• Sodium hexameta-phosphate
• Sodium tripolyphosphate
• Tetrasodium pyrophosphate
• Trisodium phosphate

On the other hand, studies revealed that only 80 per cent of the organic phosphorus from cheese is absorbed by the body.

Low Phosphorus Cheese Options

You can, instead, add low phosphorus cheese to your CKD diet. Consider these options:

1. Blue cheese - 110 mg per ounce

Enjoy your dried fruit, apples or pear slices with blue cheese. 

2. Goat Cheese - 73 mg per ounce

Whether you are crumbling it on a salad or adding it to a sandwich, goat cheese is a low phosphorus cheese option.

3. Brie Cheese - 53 mg per ounce

This versatile cheese is a great option if you need to limit your phosphorus. You can bake or grill brie cheese and consume it as a sweet appetizer or sumptuous entrée.

4. Neufchatel Cheese - 39mg per ounce

This type of cheese has some of the lowest phosphorus content per ounce.

5. Ricotta Cheese - 45 mg per ounce

This soft cheese can be enjoyed with fruits or crackers.

6. Cottage Cheese - 43 mg per ounce

Cottage cheese is low phosphorus and low protein option, which is great for patients on dialysis. Nevertheless, you need to check the cheese brand, as cottage cheese may be loaded with too much sodium.

Potassium in Cheese

Although cheese is made from milk and milk is high in potassium, most of the potassium in milk is lost during cheese processing. Most cheeses are relatively low in potassium, but you need to be wary of portion size, as large amounts of cheese can add up to your daily potassium intake. Dangerous levels of potassium (hyperkalemia) can be manifested by fatigue, numbness, nausea, muscle pains, poor appetite, and difficulty in breathing.

The National Kidney Foundation recommends 1,500-2,700 mg of potassium taken daily can help maintain good health without harming the kidneys. 

Again, you must check in with your primary health care provider to know your exact potassium limit. 

An ounce of cheese has about 35 milligrams of potassium. This means that cheeses eaten in small portions are still considered safe for a CKD diet. However, you still need to be conscious of the portion, as even the smallest quantities of cheese can have high phosphorus content. 

Protein in Cheese

It is surprising to know that some cheeses can have just as much if not more protein than meat when compared in equal amounts. Your kidneys overwork when you have too much protein in the body.

Generally, the National Kidney Foundation of Hawai’i, Inc., if you are in the early stages of CKD (stages 1 and 2), your protein limit is at 0.8 grams per kilogram of bodyweight. For CKD stages 3 to 5, you need to limit your protein to 0.55 - 0.60 grams per kilogram of body weight. Check in with your nephrologist for your exact protein intake.

Low-Protein Cheese Options

You can include these low-protein cheese options into your diet:

1. Feta Cheese - 4g per ounce

This kidney-friendly option is among the types with the lowest protein content.

2. Processed Cheese - 4g per ounce

Processed cheese is quite arbitrary as it may have less protein, yet it has one of the highest sodium contents at 477 milligrams per ounce.

3. Ricotta Cheese - 3g per ounce

Enjoy your pasta with ricotta cheese on top.

4. Neufchatel Cheese - 3g per ounce

Another low-protein cheese option is Neufchatel cheese.

5. Cream Cheese - 2g per ounce

Spread it on a cracker or your toast.

Cheese or no cheese?

Cheese is a sumptuous and versatile food that you can include in your kidney diet. However, since some cheeses are loaded with nutrients that can affect your kidney disease, it is worth keeping an eye on them. Your favorite cheese may be low in protein or potassium, but its phosphorus content can be high. Hence, it is important to read the nutrition label and watch your portion control. Always check in with your renal dietitian or primary health care provider to know more about your nutritional requirements.