Eating a balanced and kidney-friendly diet is key to help alleviate a compromised kidney for CKD patients. However, no matter how low in potassium and phosphorus your diet is, overconsumption of food may lead to the onset of diabetes and obesity, which may worsen your kidney condition. This is where Weight Management comes in. Weight management is promoting a long-term lifestyle where there is a healthy balance between proper diet and physical activity. Weight management is a key step in preventing obesity and diabetes.

One of the first steps in weight management is understanding Calories. Understanding calories is important as it is a way of tracking your food intake through their proper portion sizes and corresponding calories or the amount of energy it gives the body. Together with exercise, a balance of healthy food portions can be a way to lose weight for those obese and overweight, and maintain a healthy weight for those with normal body weight. 

The Importance of Calories

Consulting a renal dietitian will help you follow a custom meal plan that meets your nutritional requirements.

But before we get to that, we have to know, "What are Calories?

calories written

Imagine that your body is a car, and that car is powered by fuel.? The fuel that gives energy for your body to function is called Calories. These calories come from the food you are eating-- once it's metabolized. Furthermore, getting sufficient calories is essential to maintain optimum health, and aside from that, they may:

  • Help you maintain a healthy weight
  • provide your body energy to perform any physical activity
  • Help in metabolic and physiological processes of the body.

The calories that your body needs are determined by your height, weight, health condition, sex, and physical activity.  Determining the right amount of calories based on these factors helps prevent PEW ( Protein Energy Wasting) which is common in CKD. PEW is by far the strongest risk factor for negative outcomes and predictors of mortality in CKD patients.

Being overweight or obese can lead to other complications such as insulin resistance, which could further lead to Type II Diabetes. Whereas being Underweight suppresses the immune system, which can lead to the development of other illnesses t and recovery would be deemed more difficult, especially when you have Chronic Kidney Disease. 

The Basics of Calorie Management

Your new kidney-friendly diet is a balance of the right amount of nutrients served in appropriate portion sizes, which can be tracked-- when you fully understand the basis of eating a sufficient amount of calories for your daily needs. What, then,  are Calories? Calories are divided into three macronutrients. Macronutrients are the nutrients that your body needs in large amounts in order to function properly. These macronutrients are Carbohydrates, Protein, and Fat.

Let’s discuss each macronutrients to have a better understanding of each Macronutrient and how it serves the body,

Carbohydrates

Carbohydrates For healthy individuals, it provides 50-60% of their daily calorie needs. This may differ per individual depending on their health condition, weight, sex, and physical activity. Diabetic patients need to be cautious of their carbohydrate intake since it has the most impact on blood sugar levels once digested.

There are three main types of carbohydrates are: 

  • Starch
  • Sugar 
  • Fiber

The first type of carbohydrate is Starch.

Starch is a carbohydrate that is found naturally in plants. They can give the body energy and other nutrients like calcium, iron, and B vitamins that are beneficial for the body. Some examples of starch are:

Some examples of starch are:

  • Vegetables (starchy-type) like potatoes, sweet potatoes, beans, lentils, and legumes
  • Grains such as oats, barley, rice, products made of flour such as pasta, bread and crackers. 

Whole grains are an example of starch. Each whole grain is composed of three parts. The first two are the bran and the germ, which contain nutrients and fiber. The third part is the endosperm, which contains the starch. Whole grains provide vitamins, minerals, and fiber, if unprocessed. Two of the nutrients that whole grains provide are potassium and phosphorus, which CKD patients should watch out for. This is where refined grain foods come in. Refined grain food products, like white bread and plain white rice, underwent processing removing both bran and germ; thus having lesser minerals and fiber that may be a better choice for CKD patients.

The second type of carbohydrate is Sugar. 

Unlike starches, this type of carbs give fast-acting energy -- which means they are easily digested by the body and may be used immediately. 

sugary foods

There are two main sources of sugars: 

  • Naturally occurring sugars  found in certain foods like fruits and milk 
  • Commercially used sugars are found in processed foods, sugary drinks, pastries, syrups, and many more. 

Sugar found in fruits is called Fructose, while the sugar found in milk is Lactose. Both are natural sugars.  On the other hand, products with commercially used sugars contain little to zero nutrients. Examples of these products are sweetened beverages, pastries such as cakes, cookies, and muffins, and candies are a basic source of refined sugars. Overconsumption of food products high in refined sugars is associated with an increased risk of developing diabetes and other chronic illnesses. 

eating sugary food

The third type of carbohydrate is Fiber. 

Fiber is commonly found in fruits and vegetables and can help improve digestion and promote heart health.

There are 2 types of fiber, namely, insoluble and soluble fiber. Here is a quick comparison between the two:

Insoluble Fiber

Soluble Fiber

Characteristic: It cannot be dissolved by water because this is the indigestible part of the plant.

Characteristic: It can be dissolved by water and is easier to digest compared to insoluble fiber.

Food sources may be whole grains such as wheat bread, whole grain couscous, whole wheat bread, and vegetables. 

Food sources are beans, legumes, lentils, and fruits.

The health benefits of insoluble fiber include:

  • Helps in healthy digestion.
  • May help lower bad cholesterol levels in the body. 
  • Also adds a feeling of fullness when eating, which may help lessen the urge to overeat. 
  • May help lower blood sugar levels.

For a more detailed discussion of this, you may check out our article on Carb Counting.

carbs counting

Protein

Protein is a macronutrient composed of building blocks called amino acids. They help the body build muscles, repair tissues, and fight infections. intake varies depending on your CKD stage. In some cases, your dietitian may recommend monitoring your protein and having lesser portion sizes at the start of CKD. Reduced protein intake may help your kidney work less as you decrease the number of wastes in the blood system. 

Excessive intake of protein in a CKD diet can lead to glomerular hyperfiltration or a condition where the high protein in the blood causes your glomeruli (your network of capillaries where blood passes through the kidneys) to over filter, causing further damage in the glomeruli’s structure.  

Your sources of protein may come from two sources:

Animal sources - which can give high-quality protein and preferably this should be taken more than the other source of protein. Examples are Fish, Chicken, Red meat, eggs. 

Plant-based sources - plant-based proteins lack one or two amino acids, but when combined with certain food products, they can serve as high-quality protein similar to animal protein. Here are some examples of food pairings that can provide high-quality protein: 

  • Stir-fried tofu with nuts
  • Tempeh and quinoa
  • Beans and Brown rice
  • Hummus with whole-wheat pita bread

The challenge for CKD patients is that most plant-based sources contain significant levels of potassium and phosphorus. Hence, it is important to coordinate with your dietitian to achieve the right amount of nutrients that your body needs. 

Fats

These are commonly found in the oils that we use for cooking. But aside from oils, fats can also be found in nuts, beans, legumes, and fruit choices like Avocados. It comprises 15-20% of our calorie requirements per day. A teaspoon of oil can contribute 45 calories, which is why awareness of the portion sizes of fat is also important to avoid exceeding your calorie intake. 

Furthermore, it is not advisable to overeat fat. It may cause plaque build-up in the arteries, which may cause hypertension, or even worse, heart problems. This is why choosing healthier fat sources is important and can also help improve heart health.

Healthy fat sources may come from: 

  • Vegetable oils
  • Coconut oil
  • Nuts and seeds
  • Fish oils

Unhealthy fat sources are those with saturated fat and may contain trans fat, such as:

  • Butter
  • Margarine
  • Lard 
  • Creams and pastry-fillings
  • Salad dressings, if to add, choose low-salt salad dressings
  • Mayonnaise 

In addition, the cooking method for your meat or rice should contain less oil. Here are a few examples of how to cook your food:

  • Baking
  • Broiling
  • Steaming
  • Grilling
  • Poaching
  • Stir-frying in a non-stick pan (requiring less fat)
  • Roasting

Putting your Macronutrients into a meal plan

Now that you have a better understanding of what calories are composed of, you can now have an idea of how your dietitian will compute your calories and macronutrients and distribute them into your meals. 

Here is a sample condition: 

“A 40-year old man, 5’11”, 176 lbs. Normal body weight and CKD stage 1. The man works in an office 8 hours a day with minimal physical activities before and after work. “

The dietitian may ask further questions about the lifestyle of the patient, but for this condition with minimal physical activities involved, the calorie requirement maybe 2,100 calories.

From there, your dietitian will distribute the macronutrients in this process: 

Step 1: Your dietitian will first determine what your protein requirement in a day is. According to the National Kidney Foundation, the recommended dietary protein intake for CKD Stage 1 is 0.8 g per kilogram body weight. It can be computed like this: 

80 kg x 0.8g of protein = 64 g of protein per day

To convert into calories that would be = 64 g of protein x 4 = 256 calories. 

Step 2: Your dietitian will then deduct the calories from protein requirement to your total calorie needs and divide that for your Carbohydrate and Fat intake. 

2,100 calories (Total calorie requirement in a day)  - 256 calories from protein requirement = 1,844 calories remaining for carbohydrates and fat

Below is a sample of how a dietitian may divide the remaining calories for carbohydrates and fat, this may differ per individual. 

1,844 x 50% for carbohydrates = 922 calories for carbohydrates / 4 = 230 g of carbohydrates 

1,844 x 40% for fat = 737 calories for fat / 9 = 82 g of fat 

Final Diet Prescription:

2,100 calories; 64 g of Protein; 230 g of Carbohydrates; 82 g of fat

Step 3: Your dietitian will then distribute your macronutrients throughout your meals in a day. This step is important. Being vocal with your food preferences will help him/her understand your choices better and guide you on how to measure proper portion sizes.

Here is an example:

Meal

(in grams)

Carbohydrates
(230g)

Protein
(64g)

Fat
(82g)

Breakfast

65g

15g

25g

Morning snack

30g

10g

12g

Lunch

60g

15g

25g

Afternoon snack

15g

10g

0g

Dinner

60g

14g

20g

Step 4: Your dietitian will help you understand how the macronutrients are converted into household measurements and teach you an easier way of measuring your portion sizes. They will also give you a meal plan that you can follow. Here's an example:

Meal

(in grams)

Carbohydrates
(230g)

Protein
(64g)

Fat
(82g)

Breakfast

3 Waffles - 45g

-----

4oz Apple- 15g

1 Sunny side up egg - 7g

-----

2oz Ricotta Cheese - 7g

2tsp. Cooking Oil - 10g

-----

Fat from Cheese - 7g

Morning snack

Sandwich Bread Slices - 15g

-----

Fat Free Yogurt- 15g

Chicken Breast for Sandwich - 11g

1tbsp. Reduced Fat - 7g

Lunch

Vegetable Salad - 15g

-----

1/2 cup pasta - 45g

2oz Pan-fried Fish Fillet - 14g

Vinaigrette dressing - 15g

-----

4tsp. Cooking Oil (Pasta and Fish) - 20g

Afternoon snack

3/4 Unsalted pretzels - 15g

-

Fat from Pretzels - 3g

Dinner

1/2 cup rice - 30g

-----

3/4 cup blueberry shake (non-dairy) with 3/4 tbsp. sugar - 25g

3.5oz Lean Pork Tenderloin - 25g

4tsp. Cooking Oil - 20g

You can also check this link to see more of the portion sizes per macronutrient. 

Tips to help you with calorie management

To help you control your calories or healthily add calories, here are a few suggestions:

  • Start with a food diary. A food diary where you will write the food you ate and their portion sizes. In this way, you can monitor your progress and it would be easier for your dietitian to understand your diet and how to help you on your next consultation. 
  • Choose low-fat products. This goes for dairy products and salad dressings. 
  • When going out to eat at a restaurant, share a plate with your friend or eat half of the portion size. Restaurants tend to serve large portion sizes. 
  • Prefer eating homemade foods to control the amount of fat, protein, carbs, and salt being put into the meal preparation. 
  • Coordinate with your dietitian on what your food preferences are. This can help your dietitian distribute your macronutrients properly and at the same time, address your food preferences. 

Wrap-up Items 

In starting calorie management for chronic kidney disease, you would need:

  • Guidance from a professional
  • Time to understand and patience to prepare your meals
  • Discipline is choosing your food wisely

It is also crucial that you should not obsess over calories and think of the other nutrients you are getting from your food. Remember: Eating is not just to feel full, but to give the proper nutrients and calories the body needs to function correctly and, in your case, manage your kidney disease.

Sources:

How to Increase Calories in your CKD Diet; National Kidney Foundation - https://www.kidney.org/content/how-increase-calories-your-ckd-diet

Calories: A Guide to Adding or Limiting Them on the Kidney Diet; Linda M. Harvey - https://www.davita.com/diet-nutrition/articles/basics/calories-a-guide-to-adding-or-limiting-them-on-the-kidney-diet

Nutrition and Chronic Kidney Disease; National Kidney Foundation - https://unckidneycenter.org/wp-content/uploads/sites/413/2017/10/nutrition-and-chronic-kidney-disease.pdf

Kidney-friendly diet for CKD; American Kidney Fund - https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/kidney-friendly-diet-for-ckd.html

Dietary Protein Intake and Chronic Kidney Disease; Gang Jee Ko, MD, PhD,  Yoshitsugu Obi, MD, PhD, Amanda R. Tortoricci, RD,and Kamyar Kalantar-Zadeh, MD, MPH, PhD - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962279/

Types of Carbohydrates; American Diabetic Association - https://www.diabetes.org/healthy-living/recipes-nutrition/understanding-carbs/types-carbohydrates

What is starch?; StarchinFood - https://starchinfood.eu/question/what-is-starch/

Recommended Fiber Daily Intake; Fiberfacts - https://www.fiberfacts.org/consumer-recommended-daily-intake/

Fiber; Harvard School of Public Health - https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/

MyPlatePlan; U.S. Department of Agriculture - https://www.myplate.gov/myplate-plan