Going Vegetarian with Chronic Kidney Disease

RenalTracker Team: June 29, 2020

CKD-friendly Vegetarian Diet

Bowl of broccoli, onion, pepper mushroom,

Perhaps you’ve been considering the idea of going vegetarian but you’re on the fence, thinking that the diet might not meet your nutritional needs.

Well, the answer is a RESOUNDING yes. A vegetarian diet is suitable for people with kidney disease. This diet heavily consists of fruits, vegetables, nuts, and plant-based protein. CKD patients need all these food sources for their daily ammunition of protein, calories, and other essential vitamins and minerals.

While going vegetarian is good for your current kidney health status, this is not to say that you can eat any product in the market that you can find to your liking! 

Fact is, monitoring your sodium, protein, potassium, and phosphorus (SPPP), choosing and modifying the sources for these minerals and controlling the portions you consume per day still apply in this diet (with respect to your kidney function).

Read on to learn how a renal-friendly vegetarian diet is possible and what options are available for you.

The 4 Types of Vegetarian Diets

Your food and beverage choices revolve around which type of vegetarian you are. What’s more, you also need to evaluate your kidney function and how much minerals it could process.

There are 4 main classifications of vegetarian diets. These include:
  1. 1
    Lacto-ovo - Consists of plant foods, eggs, milk, and other dairy products.
  2. 2
    Lacto-vegetarian - Dairy products and plant foods, but no eggs.
  3. 3
    Pesco-vegetarian (or pescatarian) - Consists of fish, eggs, dairy products, and plant foods.
  4. 4

    Vegan - Diet which only consists of plant foods and strictly no animal products. 

No matter which type of vegetarian diet you choose, it’s important to seek the help of a renal dietitian in creating a meal plan that’s tailored to your body’s needs. Your dietitian can also guide you in selecting the right foods in appropriate amounts.

Benefits of a Vegetarian Diet

Research conducted by a group of nephrologists in Spain shows that following a plant-based diet (rich in fiber, low in saturated fat and processed meats, and including balanced SPPP levels) can:

  • Reduce protein content in urine
  • Help lower blood pressure Help manage healthy weight
  • Slow down the reduction of glomerular filtration rate (GFR), subsequently reducing the risk of CKD progression (provided that a healthy diet is complemented with regular exercise

  • Prevent tissue and kidney damage 

A vegetarian diet can be beneficial for those with early kidney disease. Cutting back on your consumption of animal-based foods helps prevent the buildup of acids in your body, therefore minimizing stress in your kidneys. 

If you have advanced-stage CKD, you may still opt for a vegetarian diet. Just make sure to get the advice of your nephrologist and/or dietitian and to consume the right nutrients in safe amounts.

Managing SPPP Levels While On a Vegetarian Diet

Limiting your SPPP intake is crucial in managing your kidney disease. The primary duty of your kidneys is to filter out potassium and phosphorus, and prevent it from building up in your blood. 

Since their kidneys are not functioning as they should, people with kidney disease are prone to having increased levels of potassium and phosphorus in their blood. This is why it’s important to keep these minerals at a minimum to avoid overworking your kidneys.

As in any kidney-friendly meal plan, your daily vegetarian meals should nourish your body with adequate amounts of protein and a healthy balance of sodium, phosphorus, and potassium. We highly encourage that you cook your own meals using fresh ingredients.

According to National Kidney Foundation, here are key things to remember about managing your SPPP levels and where to get them (Note: These are general guidelines for people with early kidney disease with 30 to 50% of normal kidney function):

Sodium

Helps maintain blood pressure as well as the liquid portion of the blood. It attracts and holds water, and too much water in the body can lead to edema. 

To limit your sodium intake, avoid putting salt in your foods (both in cooking and at the table). Read food labels carefully, making sure they say salt-free, sodium-free, unsalted, no salt added, or lightly salted.

As much as possible, limit your use of the following food items to lower your sodium:

  • Canned foods, frozen or boxed meals, and packaged vegetable broths
  • Processed dairy cheese
  • Processed foods products like veggie burgers, tofu hotdogs, frozen soy products

  • Salt, soy sauce, and other spices that contains “salt” or “sodium” in their packaging

Quitting salt doesn’t mean eliminating taste and flavor from your food. Instead of relying on salt to perk up your dishes, try replacing them with natural herbs and spices. There are many renal-friendly recipes you can explore that taste just as good without a hint of salt.

Phosphorus

The amount of phosphorus that is absorbed in your blood depends on the food you eat. About 60-80% of phosphorus content in meat is absorbed, whereas only 30 to 40% of phosphorus is absorbed from vegetarian sources. 

The best way to reduce the amount of phosphorus in your blood is to avoid meat sources and processed foods (which are rich in inorganic phosphate). Consider replacing meat with soy or unenriched rice. Eating fresh fruit and vegetables is also ideal.

Consider limiting the following foods (per day) as well:

Milk

1 cup

Cheese

2 ounces

Soy cheese

4 ounces

Yogurt

8 ounces

Pudding or custard

8 ounces

Non-fortified soy yogurt

12 ounces

When doing your groceries, read the ingredients lists and make sure the product doesn’t contain phosphate additives (e.g. sodium phosphate, aluminum phosphate, pyrophosphate, and tricalcium phosphate). Hidden phosphate additives are most common in packaged foods and fast foods.

Potassium

It helps stabilize fluid levels in your body as well as your heartbeat. But too much (or too little) potassium can overwork the kidneys and may cause heart problems. Limit your fruit and vegetable consumption to 5 servings per day or as per your doctor or dietitian’s advice.

  • Apples
  • Blackberries
  • Cranberries
  • Grapes
  • Pears
  • Mandarin oranges
  • Cherries
  • Peaches
  • Watermelon
  • Asparagus
  • Cabbage
  • Cucumber
  • Eggplant
  • Lettuce
  • Kale
  • Radish
  • Yellow squash
  • Cauliflower
  • Milk
  • Cheese
  • Yogurt

Beans, lentils and seeds can add to your potassium levels, so eat them in moderation. One way to lower the amount of potassium content in legumes is to soak and cook them.

Protein

We need protein for muscle and bone growth, but excess of this nutrient can strain impaired kidneys. The ingestion of protein generates protein wastes, but unhealthy kidneys have reduced filtering capacity to remove these wastes. Your kidneys will have to work harder to eliminate waste from protein metabolism, putting them under increased stress.

According to the U.S. Library of Medicine, how much your protein your body needs depends on your age, gender, height, weight, physical activity, your CKD stage and other factors. Once your body tissues get the protein they need for growth and repair, extra amino acids are discarded and become wastes in the urine.

Rather than adding unnecessary workload to your kidneys, make sure to take just the right protein amount that your body requires. To determine this, you need to consult with your doctor or dietitian.

Examples of kidney-friendly vegetarian protein sources are:

  • Vegan - Tofu, soy milk, soy yogurt, whole grains, wheat protein, unsalted nuts, salt-free canned/cooked peas and dried beans
  • Lacto-vegetarian - Vegan choices, plus low-sodium/reduced sodium cottage cheese

  • Lacto-ovo vegetarian - Foods listed above, including eggs
  • Pesco-vegetarian - All foods listed above

Additional Nutritional Guidelines

Below are other food items you incorporate in your diet:

Breads, grains, and cereals - For your fiber source, choose to eat whole grains. A lot of whole grain sources are abundant in phosphorus compared to breads and grains.

However, the body only absorbs 20 to 50% of them due to the phytate (a compound in plant foods that reMUduces mineral absorption) content in whole grains. Meanwhile, processed grains don’t have phytates, that’s why 100% of their phosphorus is readily absorbed by the body. 

So feel free to add 6 servings of whole grains to your diet per day. You can choose from brown rice, barley, whole grain pastas, and quinoa.
Vitamins and minerals - Due to your kidney condition, your food choices are restricted. As a result, you may not be getting all the vitamins and minerals you need per day. It may be necessary for you to take supplements to make sure your vitamin and mineral requirements are covered.
Consult your nephrologist or renal dietitian before buying any supplements. Proper assessment of your mineral levels is necessary to determine your supplement requirement.
Depending on your condition, your doctor or dietitian may recommend any of these supplements:
  • Vitamin C - Helps facilitate the healing of wounds and bruises while boosting your defense against infections.
  • Vitamin D - Keeps your teeth and bones strong. 
  • Iron - Essential for blood production, preserving vital functions of the body, and regulating body temperature.
  • Vitamin B Complex - Works with iron in preventing anemia. Helps maintain good cell health, energy levels, appetite, and digestion. 
  • Calcium - Strengthens your teeth, bones, and muscles (should be taken in moderation, as excess calcium can clump together with phosphorus and form deposits in heart, lungs, and blood vessels). 

Bottomline

A healthy, renal-friendly diet is the starting point in managing your kidney disease and preventing its progression. A regulated vegetarian diet gives you the nutritional requirements without affecting your kidneys. 

With close coordination with your nephrologist and a registered renal dietitian, you can develop a meal plan based on your CKD condition. They will also help you keep your SPPP intake at healthy levels.

If you need professional help with planning a kidney-friendly vegetarian meal plan, keep in touch with a renal dietitian, or a dietitian with experience in managing kidney disease. They can help you select the right foods and serving sizes, educate you on the possible diet adjustments you need to make, and discuss more options with you.


Sources:

Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409713/


Vegetable-Based Diets for Chronic Kidney Disease? It Is Time to Reconsider

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627351/ 


Renal diet for vegetarians: What about protein?

https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/expert-answers/renal-diet/faq-20058205


Maintaining a Vegetarian Diet with Kidney Disease

https://www.kidney.org/atoz/content/vegetarian-diet-and-ckd 


Vitamins and Minerals in Chronic Kidney Disease

https://www.kidney.org/atoz/content/vitamineral 


Management of Natural and Added Dietary Phosphorus Burden in Kidney Disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797670/