Sure, choosing which clothes to wear on an occasion can be puzzling. But have you tried hand picking the right cereal from a sea of cereal brands in a grocery store?

The variety of options can be overwhelming! The task would’ve been a no-brainer if the choice was based solely on packaging and brand popularity.

But if you have chronic kidney disease (CKD) and you’re following a specific diet, choosing the right breakfast cereal for your renal diet goes beyond brand recall and visual appeal.

Why Choose Your Cereal Carefully

The National Kidney Foundation (NKF) says that most cereal brands today contain hidden salt, phosphorus, and potassium. These additives can jack up your phosphorus and potassium levels which can be dangerous to your health.

High levels of phosphorus and potassium can cause a number of health problems including: 

• Muscle cramps and spasms
• Bone and joint pain
• Impaired nerve function
• Calcium buildup in the blood vessels, heart, and lungs
• Heart disease

People with kidney disease can prevent these health problems by sticking to a diet low in phosphorus and potassium. And it helps to be more selective of your breakfast cereal to manage your phosphorus and potassium levels.

It’s even more urgent for CKD patients undergoing hemodialysis to keep a tight control of their phosphorus intake. This is because hemodialysis only removes a small amount of phosphorus from the blood, making dialysis patients more prone to phosphorus and potassium buildup.

By limiting phosphorus in their diet (or taking medicines called phosphorus binders), they can prevent their phosphorus levels by going dangerously high.

Are Whole Grain Cereals Best for Kidney Disease?

In the past, kidney care experts used to recommend not including whole grains in the renal diet due to their high phosphorus content. But this view has changed in recent years as emerging studies begin to put whole grains in a new light.

A 2013 study titled Whole Grains in the Renal Diet - Is It Time to Reevaluate Their Role? suggests that the bioavailability (the ability of a substance to be absorbed and used by the body) of phosphate from whole grains is low, despite their high phosphorus content.

During heat treatment, phytase (the enzyme that breaks down phosphorus) in whole grains becomes inactive. When consumed, inactive phytase couldn’t break down phosphates without the help from the phytase in the human intestine.

But then the human intestinal tract lacks phytase, which makes it unable to break down organic phosphorus in whole grains. As a result, when digested, whole grains only contribute 40 to 60% of phosphorus to the bloodstream (unlike foods with phosphorus additives that contribute 90 to 100% of phosphorus).

Whole grains are rich in fiber, B vitamins, antioxidants, and phytochemicals that help:

• Improve digestion
• Reduce cholesterol
• Lower the risk of stroke, cancer, and heart disease
• Reduce inflammation associated with high fiber intake

Whole grains have various amounts of potassium and phosphorus. But before adding whole grain cereals to your diet, consult with your dietitian first. Check in with them to know if whole grains are healthy for you and to know your daily phosphorus and potassium limits.

Cereal Shopping Reminders

If your dietitian has given you the ‘Go’ signal, here are some tips to help you find the right breakfast cereal brand that suits your renal diet:

1. Cereal Shopping Reminders

Read the Nutrition Facts label. Choose the cereal that has the lowest sodium content. Sodium is indicated as mg per serving with a corresponding % Daily Value. Remember that a sodium of 5% DV or less per serving is considered low, while a 20% DV or more per serving is high.

2. Check the phosphorus content.

You want to aim for 100 mg or less of phosphorus per serving (indicated as 10% Daily Value). If you’re on dialysis, the American Kidney Fund recommends keeping your phosphorus levels within 3.0 to 5.5 mg/dL.

3. See the Ingredients list for phosphorus additives.

Avoid products that contain phosphorus additives. These additives contain ‘phos’ in them. Watch out for these common phosphorus additives found in foods:

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

4. Choose a low-sugar option.

You also want to select a breakfast cereal that has fewer amounts of sugar, especially if you have diabetes. To give you a benchmark figure, below is the American Heart Association’s (AHA) recommended daily sugar allowance for adult men and women:

• Men - No more than 150 calories on sugar per day (equivalent to 38 g or 9 tsp of sugar)
• Women - No more than 100 calories on sugar per day (equivalent to 25 g or 6 tsp of sugar)

Make sure to check the sweetener content. Sweeteners have different names like fructose, sucrose, maltose, or brown rice/corn syrup.

And be wary of the serving size. If the box says a ¾ cup of cereal contains 5 g of sugar but you usually consume 1 ½ cup, you’ll be getting a total of 10 g of sugar in one meal.  

Compare cereal brands based on their Nutrition Facts labels and go for the one that has lesser sugar. To add flavor, top your cereal with fresh, frozen, or dried fruit. A dash of cinnamon or vanilla will also do the trick.

5. Choose non-dairy milk to go with your cereal.

Almond, cashew, rice, and soy milk have less phosphorus and potassium compared to cow’s milk. Also, steer clear from cow’s milk substitutes that say ‘Enriched’ (or ‘Fortified’) somewhere in their labels.

When a product is enriched it means that nutrients were lost and were added back in during its processing to restore its original vitamin levels. While enriched products can give people their lacking vitamin and mineral needs for the day, these foods can also contribute to nutrient overdoses.

So be mindful of serving sizes to ensure you’re not going overboard with your dietitian’s recommended nutrient and vitamin allowances.

6. Try hot cereal.

Cream of wheat, cream of rice, and Malt-o-Meal are a few hot cereal options you can consider that have low phosphorus content. 

You may want to limit oatmeal to a few times a week though, as cooked oatmeal contains 176 mg of phosphorus. Oatmeal may be a great option if you’re on a high fiber diet. Discuss your options with your dietitian.

7. For ready-to-eat alternatives, choose corn-based cereals.

Looking for a low-phosphorus, low-potassium cold cereal you can eat straight out of the box? Choose corn-based cereals over bran cereals. 

One cup of bran flakes cereal contains 150 mg of phosphorus and 170 mg of potassium, whereas one cup of corn flakes only has 32 mg of potassium and 20 mg of phosphorus.

What Cereal Brands Are Good for People with Kidney Disease?

Conclusion

The best cereal brand for kidney disease is the one that’s low in phosphorus, and potassium. You also want to ensure it has low sodium content to keep it from affecting your blood pressure. 

Fiber-rich whole grain cereals are now recommended for CKD patients considering they only release 40 to 60% of phosphorus into the bloodstream. As always, seek your dietitian’s advice before adding any types of cereal to your diet.

Always check the Nutrition Facts and Ingredients labels and avoid products that have phosphorus additives. Use non-dairy milk options with your cereal as they have lesser amounts of potassium and phosphorus.