What’s good for kidney disease

Kidney disease also called renal disease, is a general term for when your kidneys are damaged and do not function as they should. If your kidney function drops below 15 percent of normal, you are said to have kidney failure. You may have symptoms from the buildup of waste products and extra water in your body. If you have kidney disease that lasts for more than 3 months, it is called chronic kidney disease or CKD. Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. When about 90% of your kidney function has been lost, kidney failure is called ‘end-stage renal disease’ or ESRD, where your kidneys have stopped working well enough for your survival without hemodialysis, peritoneal dialysis or a kidney transplant, i.e., kidney replacement therapy. Kidneys are so important that you have 2 of them — a spare if one stops working.

Your kidneys main function is to filter or ‘clean’ your blood of waste products. Healthy kidneys filter about a half cup of blood every minute about 200 quarts of fluid every 24 hours, removing wastes and extra water to make urine (about two quarts are removed from your body in the form of urine). Healthy kidneys also prevent the buildup of wastes and extra fluid in your body and balance the salts and minerals in your blood such as calcium, phosphorus, sodium, and potassium. Your kidneys also make hormones that help control your blood pressure, make red blood cells, and keep your bones strong.

To keep your kidneys healthy:

• Don’t smoke. Smoking increases your risk of cardiovascular disease, including heart attacks or strokes, which is associated with a higher risk of chronic kidney disease (CKD).
• Keep your cholesterol within healthy limits.
• Maintain a healthy diet and lifestyle. This means eating a variety of vegetables, fruits, wholegrain cereals, lean meats, poultry, fish, eggs, nuts and seeds, legumes and beans, and low-fat dairy products. Make sure you limit salt to less than 2,300 milligrams (2.3 grams) a day and limit your intake of sugar, saturated fat and trans fat. Reducing daily intake to 1,500 mg (1.5 grams) is desirable because it can lower blood pressure even further. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat. In the later stages of chronic kidney disease, you may need to follow specific instructions from your doctor and dietitian on what you can eat or drink while maintaining your kidney health.
• Maintain a healthy weight. If you have chronic kidney disease, you should ideally have a BMI (body mass index) of 25 or less. Being overweight increases your risk of diabetes and high blood pressure, which in turn increase your risk of kidney disease.
• Exercise regularly (this reduces your risk of heart disease and high blood pressure, both risk factors for kidney disease). Aim to be active on most, preferably all, days of the week with 150-300 minutes of moderate activity per week (e.g. walking, gardening, using the stairs instead of the lift) or 75-150 minutes of vigorous activity (e.g. jogging, circuit class, weights), as well as strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).
• Drink plenty of water. Avoid sugary drinks (such as soft drinks).
• People with diabetes should keep blood glucose within recommended levels
• Limit your intake of alcohol to no more than one drink per day if you are a woman and no more than two if you are a man. Drinking too much alcohol can damage the liver, heart, and brain and cause serious health problems. Drinking excessive amounts of alcohol can also cause your blood pressure and cholesterol levels to rise to unhealthy levels.
• Quickly treat any urinary tract infections or kidney stones
• Find ways to help you relax and reduce stress
• Be aware of your risk factors — if you know you are at risk of kidney disease, you can have your kidneys checked regularly

When your kidneys do not work properly, wastes and fluids build up inside your body and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

• Symptoms of acute kidney failure (temporary loss of kidney function lasting less than three months) can include decreased amount of urine, fluid retention, confusion, nausea and chest pain. Many people fully recover from an acute kidney injury and go on to live a normal life. However, if significant damage has been caused, there is a higher risk of developing chronic (or ongoing) kidney disease later on.
• Symptoms of chronic kidney failure (lifelong kidney failure occurs when your kidneys have been damaged in a way that cannot be reversed) may include tiredness, weakness, nausea, vomiting, itching, restless legs, breathlessness, high blood pressure that can’t be controlled and night-time urination. If you notice any such symptoms, see your doctor.

The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.

Other conditions that affect your kidneys are:

• Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney’s filtering units called the glomeruli. These disorders are the third most common type of kidney disease. Glomerulonephritis may happen suddenly, for example, after a strep throat, and the individual may get well again.However, the disease may develop slowly over several years and it may cause progressive loss of kidney function.
• Inherited diseases (run in families), such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue. Polycystic kidney disease is the most common inherited kidney disease. Other inherited diseases that affect the kidneys include Alport’s Syndrome,primary hyperoxaluria and cystinuria.
• Kidney stones are very common, and when they pass, they may cause severe pain in your back and side. There are many possible causes of kidney stones, including an inherited disorder that causes too much calcium to be absorbed from foods and urinary tract infections or obstructions. Sometimes, medications and diet can help to prevent recurrent stone formation. In cases where stones are too large to pass, treatments may be done to remove the stones or break them down into small pieces that can pass out of the body.
• Malformations that occur as a baby develops in its mother’s womb also known as congenital diseases. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
• Lupus and other diseases that affect the body’s immune system.
• Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.
• Repeated urinary infections.
• Drugs and toxins can also cause kidney problems. Using large numbers of over-the-counter pain relievers for a long time may be harmful to the kidneys. Certain other medications, toxins, pesticides and “street” drugs such as heroin and crack can also cause kidney damage.

Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

1. High blood pressure.
2. Blood and/or protein in the urine.
3. A creatinine and Blood Urea Nitrogen (BUN) blood test, outside the normal range. BUN and creatinine are waste that build up in your blood when your kidney function is reduced.
4. A glomerular filtration rate (GFR) less than 60. GFR is a measure of kidney function.
5. More frequent urination, particularly at night; difficult or painful urination.
6. Puffiness around your eyes, swelling of your hands and feet.

According to the National Kidney Foundation, about 1 in 3 American adults is at risk for kidney disease. Approximately, 37 million American adults have kidney disease and most don’t know it. And nearly 100,000 Americans are on the waiting list for a kidney transplant and about 12 people die each day waiting for a kidney transplant ¹.

Doing well with kidney failure is a challenge. You will feel better if you:

• stick to your treatment schedule
• review your medicines with your health care provider at every visit and take your medicines as prescribed
• work with a dietitian to develop an eating plan that includes foods you enjoy eating while also helping your health
• stay active—take a walk or do some other physical activity that you enjoy
• stay in touch with your friends and family

Treatment with dialysis or transplant will help you feel better and live longer. Your health care team will work with you to create a treatment plan to address any health problems you have. Your treatment will include steps you can take to maintain your quality of life and activity level.

Your eating plan plays an important role. When you have kidney failure, what you eat and drink may help you maintain a healthy balance of salts, minerals, and fluids in your body.

What foods are good for kidney disease?

To achieve good kidney health, it’s important to follow a healthy diet and maintain a healthy weight. This means eating a good variety of nutritious foods and watching your serving size. You may need to change what you eat to manage your chronic kidney disease (CKD). Work with a registered dietitian to develop a meal plan that includes foods that you enjoy eating while maintaining your kidney health.

Contrary to popular belief, patients with kidney disease CAN include fruit and vegetables, even with the dreaded potassium restrictions. Fruit and vegetables are an important part of a healthy, balanced diet and provide many vitamins and minerals, fiber and taste.

Choose and prepare foods with less salt and sodium

Salt or sodium is a mineral that’s essential for life. Table salt is a combination of two minerals — about 40% sodium and 60% chloride. Salt or sodium is regulated by your kidneys, and it helps control your body’s fluid balance. It also helps send nerve impulses and affects muscle function. High levels of salt in your diet can increase blood pressure. High blood pressure is known as the “silent killer” because its symptoms are not always obvious. It’s one of the major risk factors for heart disease, the No. 1 killer worldwide. Ninety percent of American adults are expected to develop high blood pressure over their lifetimes. Because high blood pressure is an important risk factor for stroke, and strokes are detrimental to cognitive health, excessive salt intake is harmful for your brain health. There is a well-established relationship between consuming high levels of sodium and risk of stroke. In Japan, a public health education intervention in the 1960s showed the effectiveness of dietary interventions to reduce sodium intake. A 50% reduction in salt in the diet was associated with an 85% reduction in mortality caused by stroke.

Most of the salt that you eat is added to processed foods. More than 70% of the sodium you consume comes from packaged, prepared and restaurant foods. The rest of the sodium in the diet occurs naturally in food (about 15 percent) or is added when we’re cooking food or sitting down to eat (about 11 percent). Current recommendations from the Dietary Guidelines for Americans are to limit sodium intake to 2,300 milligrams (mg) a day, which amounts to about one teaspoon of salt. The American Heart Association recommends an ideal limit of no more than 1,500 mg per day for most adults. On average, Americans eat more than 3,400 milligrams of sodium each day — much more than the American Heart Association and other health organizations recommend. Because the average American eats so much excess sodium, even cutting back by 1,000 milligrams a day can significantly improve blood pressure and heart health. One estimate suggested that if the U.S. population dropped its sodium intake to 1,500 mg/day (1/2 teaspoon salt), overall blood pressure could decrease by 25.6%, with an estimated $26.2 billion in health care savings. Another estimate projected that achieving this goal would reduce cardiovascular disease deaths by anywhere from 500,000 to nearly 1.2 million over the next decade.

Here are the approximate amounts of sodium in a given amount of salt:

• 1/4 teaspoon salt = 575 mg sodium
• 1/2 teaspoon salt = 1,150 mg sodium
• 3/4 teaspoon salt = 1,725 mg sodium
• 1 teaspoon salt = 2,300 mg sodium

The body needs only a small amount of sodium (less than 500 milligrams per day) to function properly. That’s a mere smidgen — the amount in less than ¼ teaspoon. Very few people come close to eating less than that amount. Plus, healthy kidneys are great at retaining the sodium that your body needs.

To help control your blood pressure. Your diet should contain less than 2,300 milligrams of sodium each day.

• Buy fresh food often. Sodium (a part of salt) is added to many prepared or packaged foods you buy at the supermarket or at restaurants.
• Cook foods from scratch instead of eating prepared foods, “fast” foods, frozen dinners, and canned foods that are higher in sodium. When you prepare your own food, you control what goes into it.
• Use spices, herbs, and sodium-free seasonings in place of salt.
• Check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 percent or more means the food is high in sodium.
• Try lower-sodium versions of frozen dinners and other convenience foods.
• Rinse canned vegetables, beans, meats, and fish with water before eating.

Look for food labels with words like sodium free or salt free; or low, reduced, or no salt or sodium; or unsalted or lightly salted.

Eat the right amount and the right types of protein

Protein is vital. It is your body’s main building block. Proteins help build and maintain muscle, bone, skin, connective tissue, internal organs, and blood. They help fight disease and heal wounds. Protein is found in foods from plants and animals. Animal products such as meat, fish, eggs and dairy are good sources of dietary protein. Meat and fish also provide your body with a form of iron (heme), which is easy to absorb. Fish also contains essential fatty acids (e.g, Omega-3).

Animal-protein foods:

• Chicken
• Fish
• Meat
• Eggs
• Dairy

Protein also comes from foods of plant origin. Pulses, nuts, and seeds are all high in protein. Pulses are a very good meat alternative, whether or not you are vegetarian or vegan.

Plant-protein foods:

• Beans
• Nuts
• Grains

Most people eat both types of protein. Talk to your dietitian about how to choose the right combination of protein foods for you.

Eating more protein than the body needs may put an extra burden on the kidneys and cause kidney function to decline faster. To help protect your kidneys eat smaller portions of protein foods. When your body uses protein, it produces waste. Your kidneys remove this waste. Eating more protein than you need may make your kidneys work harder, so people with chronic kidney disease (CKD) may need to eat less protein.

Health care providers recommend that people with CKD eat moderate or reduced amounts of protein. However, restricting protein could lead to malnutrition, so people with CKD need to be careful. The typical American diet contains more than enough protein. Learning about portion sizes can help people limit protein intake without endangering their health.

Your dietitian will tell you what amount and types of protein are right for you.

Most people—with or without chronic kidney disease (CKD)—can get the daily protein they need by eating two 3-ounce servings of meat or meat substitute. A 3-ounce serving of meat is about the size of a deck of cards or the palm of a person’s hand.

Here is some general information about protein types and serving sizes:

• Eat smaller portions of meat and dairy. This will also help you lower the amount of phosphorus in your diet, because phosphorus is found in meat and dairy foods.
  • Meat, poultry and fish: A cooked portion of chicken, fish, or meat is about 2 to 3 ounces or about the size of a deck of cards.
  • Dairy foods: A portion of dairy foods is ½ cup of milk or yogurt, or one slice of cheese.
• Plant proteins should make up the rest of the protein that you eat.
  • A serving is:
    • ½ cup of cooked beans
    • ¼ cup of nuts
    • a slice of bread
    • ½ cup of cooked rice or noodles

There are many good sources of protein for people who do not eat meat or dairy foods. Talk to your dietitian about how to combine plant proteins to be sure you are getting all of the building blocks your body needs.

Choose foods that are healthy for your kidneys

To help keep fat from building up in your blood vessels, heart, and kidneys.

• Grill, broil, bake, roast, or stir-fry foods, instead of deep frying.
• Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
• Trim fat from meat and remove skin from poultry before eating.
• Try to limit saturated and trans fats. Read the food label.

Kidney-healthy foods:

• Lean cuts of meat, such as loin or round
• Poultry without the skin
• Fish
• Beans
• Vegetables
• Fruits
• Low-fat or fat-free milk, yogurt, and cheese

Fats

Fats also known as lipids, is an essential nutrient (a primary storage form of energy, a kilojoule-dense nutrient) your body need for energy and to help your gut absorb vitamins A, D, E and K from foods. Fat has twice as many calories as proteins or carbohydrates. There are nine calories (37kJ) in every gram of fat, regardless of what type of fat it is. Fats are more energy-dense than carbohydrates and proteins, which provide four calories (17kJ) per gram. Dietary fat also plays a major role in your cholesterol levels. You need some fat in your diet but not too much. There are different types of fats, some are “good” and some are “bad”, however, you should try to avoid “bad” fats. When it comes to dietary fat, what matters most is the type of fat you eat. Contrary to past dietary advice promoting low-fat diets, newer research shows that healthy fats are necessary and beneficial for health.

Healthy fats are unsaturated. They keep cholesterol levels within a healthy range, reduce your risk of heart problems and may be good for the skin, eyes and brain. Unsaturated fats are the best choice for a healthy diet.

Unhealthy fats are saturated and trans fats, which can raise levels of ‘bad’ cholesterol and increase the risk of heart disease. Multiple studies have linked high levels of saturated fat with cognitive decline. A diet that is higher in unsaturated fats and lower in saturated fats is linked to better cognition.

• Saturated fats such as butter, solid shortening, and lard. Eating foods that contain saturated fats raises the level of cholesterol in your blood. High levels of LDL cholesterol (low-density lipoprotein or “bad” cholesterol) in your blood increase your risk of heart disease and stroke. The American Heart Association recommends aiming for a dietary pattern that achieves 5% to 6% of calories from saturated fat. For example, if you need about 2,000 calories a day, no more than 120 of them should come from saturated fat. That’s about 13 grams of saturated fat per day ².
• Trans fats also known as trans fatty acids or “partially hydrogenated oils”. These are found in vegetable shortenings, some margarines, crackers, cookies, snack foods, and other foods made with or fried in partially hydrogenated oils. By 2018, most U.S. companies will not be allowed to add partially hydrogenated oils to food.

People with chronic kidney disease (CKD) are at higher risk of having a heart attack or stroke. Therefore, people with chronic kidney disease (CKD) should be especially careful about how dietary fat affects their heart health. People with advanced chronic kidney disease (CKD) should talk with a dietitian about healthy and unhealthy sources of fat. Saturated fats and trans-fatty acids can raise blood cholesterol levels and clog blood vessels. Saturated fats are found in animal products such as red meat, poultry, whole milk, and butter. These fats are usually solid at room temperature. Trans-fatty acids are often found in commercially baked goods such as cookies and cakes and in fried foods like doughnuts and french fries.

“Bad” fats, such as artificial trans fats and saturated fats, are guilty of the unhealthy things all fats have been blamed for—weight gain, clogged arteries, an increased risk of certain diseases, and so forth. Large studies have found that replacing saturated fats in your diet with unsaturated fats and omega-3 fatty acids can reduce your risk of heart disease by about the same amount as cholesterol-lowering drugs. Since fat is an important part of a healthy diet, rather than adopting a low-fat diet, it’s more important to focus on eating more beneficial “good” fats and limiting harmful “bad” fats. For good health, the majority of the fats that you eat should be monounsaturated or polyunsaturated. Eat foods containing monounsaturated fats and/or polyunsaturated fats such as canola oil, olive oil, safflower oil, sesame oil or sunflower oil instead of foods that contain saturated fats and/or trans fats.

For years you’ve been told that eating fat will add inches to your waistline, raise cholesterol, and cause a myriad of health problems. When food manufacturers reduce fat, they often replace it with carbohydrates from sugar, refined grains, or other starches. Your body digests these refined carbohydrates and starches very quickly, affecting your blood sugar and insulin levels and possibly resulting in weight gain and disease ³. But now scientists know that not all fat is the same. Research has shown that unsaturated fats are good for you. Healthy fats play a huge role in helping you manage your moods, stay on top of your mental game, fight fatigue, and even control your weight. These fats come mostly from plant sources. Cooking oils that are liquid at room temperature, such as canola, peanut, safflower, soybean, and olive oil, contain mostly unsaturated fat. Nuts, seeds, and avocados are also good sources. Fatty fish—such as salmon, sardines, and herring—are rich in unsaturated fats, too. You should actively make unsaturated fats a part of your diet. Of course, eating too much fat will put on the pounds too. Note also that by swapping animal fats for refined carbohydrates—such as replacing your breakfast bacon with a bagel or pastry—won’t have the same benefits. In fact eating refined carbohydrates or sugary foods can have a similar negative effect on your cholesterol levels, your risk for heart disease, and your weight. Limiting your intake of saturated fat can still help improve your health—as long as you take care to replace it with good fat rather than refined carbs. In other words, don’t go no fat, go good fat.

Healthy-eating tips:

• Use olive oil in cooking.
• Replace saturated fats with unsaturated fats; for example, use avocado, tahini, nut or seed butter instead of dairy butter.
• Eat fish, especially oily fish, twice a week.
• Consume legume- or bean-based meals twice a week.
• Snack on nuts or add them to your cooking.
• Throw avocado in salads.
• Choose lean meats and trim any fat you can see (including chicken skin).
• Use table spreads that have less than 0.1g of trans fats per 100g.

Saturated fats

Saturated fats are fat molecules that are “saturated” with hydrogen molecules. Saturated fats are normally solid at room temperature. Saturated fats occur naturally in many foods — primarily meat and dairy foods (butter, cream, full-fat milk and cheese). Beef, lamb, pork on poultry (with the skin on) contain saturated fats, as do butter, cream and cheese made from whole or 2% milk. Plant-based foods that contain saturated fats include coconut, coconut oil, coconut milk and coconut cream, cooking margarine, and cocoa butter, as well as palm oil and palm kernel oil (often called tropical oils). Saturated fats are also found in snacks like chips, cakes, biscuits and pastries, and takeaway foods. Consuming more than the recommended amount of saturated fat is linked to heart disease and high cholesterol.

The American Dietary Guidelines recommend that:

• men should not eat more than 30g of saturated fat a day
• women should not eat more than 20g of saturated fat a day
• children should have less

For people who need to lower their cholesterol, the American Heart Association recommends reducing saturated fat to less than 6% of total daily calories. For someone eating 2,000 calories a day, that’s about 11 to 13 grams of saturated fat ².

Examples of foods with saturated fat are:

• fatty beef,
• lamb,
• pork,
• poultry with skin,
• beef fat (tallow),
• meat products including sausages and pies,
• lard and cream,
• butter and ghee,
• cheese especially hard cheese like cheddar,
• other dairy products made from whole or reduced-fat (2 percent) milk,
• cream, soured cream and ice cream,
• some savory snacks, like cheese crackers and some popcorns,
• chocolate confectionery,
• biscuits, cakes, and pastries

In addition, many baked goods and fried foods can contain high levels of saturated fats. Some plant-based oils, such as palm oil, palm kernel oil, coconut oil and coconut cream, also contain primarily saturated fats, but do not contain cholesterol.

Unsaturated Fats

If you want to reduce your risk of heart disease, it’s best to reduce your overall fat intake and swap saturated fats for unsaturated fats. Unsaturated fats are in fish, such as salmon, trout and herring, and plant-based foods such as avocados, olives and walnuts. Liquid vegetable oils, such as soybean, corn, safflower, canola, olive and sunflower, also contain unsaturated fats.

There are 2 types of unsaturated fats: monounsaturated and polyunsaturated. Unsaturated fats help reduce your risk of heart disease and lower your cholesterol levels.

• Polyunsaturated fats such as omega-3 and omega-6 fats are found in fish, nuts, and safflower and soybean oil.
• Monounsaturated fats are found in olive and canola oil, avocado, cashews and almonds.

Monounsaturated fats have one (“mono”) unsaturated carbon bond in the molecule. Polyunsaturated fats have more than one (“poly,” for many) unsaturated carbon bonds. Both of these unsaturated fats are typically liquid at room temperature.

Eaten in moderation, both kinds of unsaturated fats may help improve your blood cholesterol when used in place of saturated and trans fats.

Polyunsaturated fats

Polyunsaturated fats are simply fat molecules that have more than one unsaturated carbon bond in the molecule, this is also called a double bond. Oils that contain polyunsaturated fats are typically liquid at room temperature but start to turn solid when chilled. Olive oil is an example of a type of oil that contains polyunsaturated fats.

There are 2 main types of polyunsaturated fats: omega-3 and omega-6. Oils rich in polyunsaturated fats also provide essential fats that your body needs but can’t produce itself – such as omega-6 and omega-3 fatty acids. You must get essential fats through food. Omega-6 and omega-3 fatty acids are important for many functions in the body. A deficiency of essential fatty acids—either omega-3s or omega-6s—can cause rough, scaly skin and dermatitis ⁴.

Polyunsaturated fats can help reduce bad cholesterol levels in your blood which can lower your risk of heart disease and stroke. Polyunsaturated fats also provide nutrients to help develop and maintain your body’s cells. Oils rich in polyunsaturated fats also contribute vitamin E to the diet, an antioxidant vitamin most Americans need more of.

Foods high in polyunsaturated fat include a number of plant-based oils, including:

• soybean oil
• corn oil
• sunflower oil

Other sources include some nuts and seeds such as walnuts and sunflower seeds, tofu and soybeans.

Omega-6 fats are found in vegetable oils, such as:

• rapeseed
• corn
• sunflower
• some nuts

Omega-3 fats are found in oily fish, such as:

• kippers
• herring
• trout
• sardines
• salmon
• mackerel

The American Heart Association also recommends eating tofu and other forms of soybeans, canola, walnut and flaxseed, and their oils. These foods contain alpha-linolenic acid (ALA), another omega-3 fatty acid.

Polyunsaturated fats (PUFAs) are frequently designated by their number of carbon atoms and double bonds. Alpha-linolenic acid (ALA), for example, is known as C18:3n-3 because it has 18 carbons and 3 double bonds and is an omega-3 fatty acid. Similarly, eicosapentaenoic acid (EPA) is known as C20:5n-3 and docosahexaenoic acid (DHA) as C22:6n-3. Omega-6 fatty acids (omega-6s) have a carbon–carbon double bond that is six carbons away from the methyl end of the fatty acid chain. Linoleic acid (LA) known as C18:2n-6 and arachidonic acid (AA) known as C20:4n-6 are two of the major omega-6s.

The human body can only form carbon–carbon double bonds after the 9th carbon from the methyl end of a fatty acid ⁵. Therefore, alpha-linolenic acid (ALA) and linoleic acid (LA) are considered essential fatty acids, meaning that they must be obtained from the diet ⁶. Alpha-linolenic acid (ALA) can be converted into eicosapentaenoic acid (EPA) and then to docosahexaenoic acid (DHA), but the conversion (which occurs primarily in the liver) is very limited, with reported rates of less than 15% ⁷. Therefore, consuming EPA and DHA directly from foods and/or dietary supplements is the only practical way to increase levels of these fatty acids in the body.

Alpha-linolenic acid (ALA) is present in plant oils, such as flaxseed, soybean, and canola oils ⁷. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are present in fish, fish oils, and krill oils, but they are originally synthesized by microalgae, not by the fish. When fish consume phytoplankton that consumed microalgae, they accumulate the omega-3s in their tissues ⁷.

Some researchers propose that the relative intakes of omega-6s and omega-3s—the omega-6/omega-3 ratio—may have important implications for the pathogenesis of many chronic diseases, such as cardiovascular disease and cancer ⁸, but the optimal ratio—if any—has not been defined ⁹. Others have concluded that such ratios are too non-specific and are insensitive to individual fatty acid levels ¹⁰. Most agree that raising eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) blood levels is far more important than lowering linoleic acid (LA) or arachidonic acid levels.

Currently, most clinicians do not assess omega-3 status, but it can be done by measuring individual omega-3s in plasma or serum phospholipids and expressing them as the percentage of total phospholipid fatty acids by weight ¹¹. Experts have not established normal ranges, but mean values for serum or plasma phospholipid eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) among U.S. adults not taking omega-3 supplements are about 3%–4% ¹¹. Plasma and serum fatty acid values, however, can vary substantially based on an individual’s most recent meal, so they do not reflect long-term dietary consumption ¹².

It is also possible to assess omega-3 status via analysis of erythrocyte fatty acids, a measurement that reflects longer-term intakes over approximately the previous 120 days ¹³. The “omega-3 index” proposed by Harris and von Schacky reflects the content of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) in erythrocyte membranes expressed as a percentage of total erythrocyte fatty acids ¹⁴. This index can be used as a surrogate for assessing tissue levels of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) ¹⁵. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) typically comprise about 3%–5% of erythrocyte fatty acids in Western populations with low fish intakes. In Japan, where fish consumption is high, erythrocyte eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels are about twice those of Western populations ⁷.

Table 1. Alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content of selected foods

Food	Grams per serving
	ALA	DHA	EPA
Flaxseed oil, 1 tbsp	7.26
Chia seeds, 1 ounce	5.06
English walnuts, 1 ounce	2.57
Flaxseed, whole, 1 tbsp	2.35
Salmon, Atlantic, farmed cooked, 3 ounces		1.24	0.59
Salmon, Atlantic, wild, cooked, 3 ounces		1.22	0.35
Herring, Atlantic, cooked, 3 ounces*		0.94	0.77
Canola oil, 1 tbsp	1.28
Sardines, canned in tomato sauce, drained, 3 ounces*		0.74	0.45
Mackerel, Atlantic, cooked, 3 ounces*		0.59	0.43
Salmon, pink, canned, drained, 3 ounces*	0.04	0.63	0.28
Soybean oil, 1 tbsp	0.92
Trout, rainbow, wild, cooked, 3 ounces		0.44	0.4
Black walnuts, 1 ounce	0.76
Mayonnaise, 1 tbsp	0.74
Oysters, eastern, wild, cooked, 3 ounces	0.14	0.23	0.3
Sea bass, cooked, 3 ounces*		0.47	0.18
Edamame, frozen, prepared, ½ cup	0.28
Shrimp, cooked, 3 ounces*		0.12	0.12
Refried beans, canned, vegetarian, ½ cup	0.21
Lobster, cooked, 3 ounces*	0.04	0.07	0.1
Tuna, light, canned in water, drained, 3 ounces*		0.17	0.02
Tilapia, cooked, 3 ounces*	0.04	0.11
Scallops, cooked, 3 ounces*		0.09	0.06
Cod, Pacific, cooked, 3 ounces*		0.1	0.04
Tuna, yellowfin, cooked 3 ounces*		0.09	0.01
Kidney beans, canned ½ cup	0.1
Baked beans, canned, vegetarian, ½ cup	0.07
Ground beef, 85% lean, cooked, 3 ounces**	0.04
Bread, whole wheat, 1 slice	0.04
Egg, cooked, 1 egg		0.03
Chicken, breast, roasted, 3 ounces		0.02	0.01
Milk, low-fat (1%), 1 cup	0.01

Footnotes: *Except as noted, the U.S. Department of Agriculture (USDA) database does not specify whether fish are farmed or wild caught. **The USDA database does not specify whether beef is grass fed or grain fed.

Essential Fatty Acids

Essential Fatty Acids such as omega-3 oils are ‘essential’ because your body can’t make them and you have to obtain them from your food. Essential Fatty Acids are found in the skin of white fish but also in the flesh of oily fish such as fresh and tinned salmon, mackerel, sardines and fresh tuna. Advice for fish eaters is to have one portion of oily fish, and one portion of white fish per week.

Essential Fatty Acids can also be found in some plant oils such as flaxseed, rapeseed and soya but there is not as much in these oils as there is in fish and seafood.

Omega-3 fatty acids

Omega-3 fatty acids (omega-3s) are a type of polyunsaturated fat and have a carbon–carbon double bond located three carbons from the methyl end of the chain (see Figure 6). Omega-3 fatty acids, sometimes referred to as “n-3s,” are present in certain foods such as flaxseed and fish, as well as dietary supplements such as fish oil. Omega-3 fatty acids are especially beneficial to your health. Omega-3s play important roles in the body as components of the phospholipids that form the structures of cell membranes ⁴. There are different types of omega-3s: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are found in fish and algae and have the most health benefits, while alpha-linolenic acid (ALA) comes from plants and is a less potent form of omega-3, although the body does convert ALA to EPA and DHA at low rates. Alpha-linolenic acid (ALA) contains 18 carbon atoms, whereas eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) are considered “long-chain” omega-3s because EPA contains 20 carbons and DHA contains 22 ¹⁵.

Docosahexaenoic acid (DHA), in particular, is especially high in the retina, brain, and sperm ⁷. In addition to their structural role in cell membranes, omega-3s (along with omega-6s) provide energy for the body and are used to form eicosanoids. Eicosanoids are signaling molecules that have similar chemical structures to the fatty acids from which they are derived; they have wide-ranging functions in the body’s cardiovascular, pulmonary, immune, and endocrine systems ⁵. Higher concentrations of EPA and DHA than arachidonic acid tip the eicosanoid balance toward less inflammatory activity ¹⁶.

Research has shown that a diet rich in omega-3 fatty acids may help to:

• Prevent and reduce symptoms of depression, ADHD, and bipolar disorder.
• Protect against memory loss and dementia.
• Reduce the risk of heart disease, stroke, and cancer.
• Ease arthritis, joint pain, and inflammatory skin conditions.
• Support a healthy pregnancy.
• Battle fatigue, sharpen your memory, and balance your mood.

Fish the best source of omega-3 (high in EPA and DHA):

• Anchovies
• Herring
• Salmon
• Mackerel
• Sardines
• Trout
• Tuna
• Mussels
• Oysters
• Halibut

Vegetarian sources of omega-3s (high in ALA):

• Algae such as seaweed (high in EPA and DHA)
• Eggs (small amounts of DHA)
• Flaxseeds and flaxseed oil
• Chia seeds
• Canola and soybean oil
• Walnuts
• Mayonnaise
• Edamame
• Beans (refried, kidney, etc.)
• Brussels sprouts
• Kale
• Spinach

Fish is a good source of protein and omega-3 fatty acids, which are good for your heart. Research has shown that omega-3 fatty acids can reduce your risk of heart disease and stroke. A 2020 Cochrane review ¹⁷ of 86 randomized controlled trials published between 1968 and 2019 found that 0.5 g/day to more than 5 g/day omega-3 fatty acids for 12 to 88 months in a total of 162,796 participants reduced serum triglyceride levels by about 15% and slightly decreased rates of cardiovascular mortality and coronary heart disease events. However, the omega-3 fatty acids supplements did not affect all-cause mortality, cardiovascular events, stroke, or arrhythmia. The authors of several earlier meta-analyses and systematic reviews, as well as a 2016 report from the Agency for Healthcare Research and Quality, concluded that omega-3 fatty acids supplements do not appear to significantly reduce the risk of most cardiovascular events ¹⁸. Many of these analyses ¹⁹, however, but not all ²⁰, did find that omega-3s reduce the risk of cardiac death.

The American Heart Association recommends eating 2 servings of fish (particularly fatty fish) per week. A serving is 3.5 ounce (100 g) cooked, or about ¾ cup of flaked fish. Fatty fish like salmon, mackerel, herring, lake trout, sardines and albacore tuna are high in omega-3 fatty acids. For people with existing coronary heart disease, such as a recent heart attack (myocardial infarction), the American Heart Association recommends approximately 1 gram/day EPA plus DHA, preferably from oily fish; however, supplements could also be considered under the direction of a physician ²¹. The American Heart Association does not recommend omega-3 supplements for people who do not have a high cardiovascular disease risk.

While omega-3s are best obtained through food, there are many omega-3 and fish oil supplements available. A typical fish oil supplement provides about 1,000 mg fish oil, containing 180 mg EPA and 120 mg DHA, but doses vary widely ²². If you need to substantially lower your triglycerides, your doctor may recommend prescription fish oil, which has been concentrated to contain about 900 mg of EPA plus DHA per capsule. Cod liver oil supplements provide vitamin A and vitamin D in addition to omega-3s. For strict vegetarians or vegans, as well as obtaining ALA from food sources, look for capsules containing DHA and EPA extracted from algae, the original source of omega-3s for fish. Although seafood contains varying levels of methyl mercury (a toxic heavy metal) ²³, omega-3 supplements have not been found to contain this contaminant because it is removed during processing and purification ²⁴.

Some types of fish may contain high levels of mercury, PCBs (polychlorinated biphenyls), dioxins and other environmental contaminants. Levels of these substances are generally highest in older, larger, predatory fish and marine mammals.

The benefits and risks of eating fish vary depending on a person’s stage of life.

Children and pregnant women are advised by the U.S. Food and Drug Administration (FDA) to:

• Avoid eating those fish with the potential for the highest level of mercury contamination (such as shark, swordfish, king mackerel or tilefish).
• Eat a variety of fish and shellfish that are lower in mercury (such as canned light tuna, salmon, pollock, catfish).
• Check local advisories about the safety of fish caught by family and friends in local lakes, rivers and coastal areas.

For middle-aged and older men and postmenopausal women, the benefits far outweigh the potential risks when the amount of fish eaten is within the recommendations established by the FDA and Environmental Protection Agency.

Eating a variety of fish will help minimize any potentially adverse effects due to environmental pollutants. Five of the most commonly eaten fish or shellfish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish. Avoid eating shark, swordfish, king Mackerel, or tilefish because they contain high levels of mercury.

Cholesterol

Dietary fat plays a major role in your cholesterol levels. Cholesterol is a type of fat, a wax-like substance that your body needs to function properly that comes from foods such as eggs and is also found in your blood mostly made by your body in your liver. In and of itself, cholesterol isn’t bad. But when you get too much of it, it can have a negative impact on your health. The 2 main types of cholesterol are:

1. “Good” cholesterol or HDL (high-density lipoprotein) cholesterol. “Good” HDL cholesterol has a positive effect by taking cholesterol from parts of the body where there’s too much of it to the liver, where it’s disposed of.
   
2. “Bad” cholesterol or LDL (low-density lipoprotein) cholesterol.

High levels of LDL cholesterol (low-density lipoprotein or “bad” cholesterol) can increase your risk of heart disease. The key is to keep your LDL levels low and HDL high, which may protect against heart disease and stroke. High levels of LDL cholesterol (low-density lipoprotein or “bad” cholesterol) can clog arteries and low HDL (high-density lipoprotein or “good” cholesterol) can be a marker for increased cardiovascular risk. However, eating foods that contain any type of cholesterol won’t actually raise your body’s cholesterol levels. Rather than the amount of cholesterol you eat, the biggest influence on your cholesterol levels is the type of fats you consume. Eating saturated or trans fats is far more likely to give you high cholesterol. So instead of counting cholesterol, it’s important to focus on replacing bad fats with good fats.

LDL (bad) cholesterol

LDL (low-density lipoprotein) cholesterol is considered the “bad” cholesterol, because it contributes to fatty buildups in arteries (atherosclerosis). This narrows the arteries and increases the risk for heart attack, stroke and peripheral artery disease. Your body naturally produces all the LDL cholesterol you need. Eating foods containing saturated fats and trans fats causes your body to produce even more LDL — raising the level of “bad” cholesterol in your blood.

HDL (good) cholesterol

HDL (high-density lipoprotein) cholesterol can be thought of as the “good” cholesterol because a healthy level may protect against heart attack and stroke. HDL carries LDL (bad) cholesterol away from the arteries and back to the liver, where the LDL is broken down and passed from the body. But HDL cholesterol doesn’t completely eliminate LDL cholesterol. Only one-third to one-fourth of blood cholesterol is carried by HDL.

Trans fats

Avoid trans fat. Trans fats also known as trans fatty acids or “partially hydrogenated oils”, are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid, so they ‘behave’ like a saturated fat. There are two broad types of trans fats found in foods: naturally-occurring and artificial trans fats. Naturally-occurring trans fats are produced in the gut of some animals and foods made from these animals (e.g., milk and meat products) may contain small quantities of these fats. Artificial trans fats (or trans fatty acids) are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid.

Trans fats increase the levels of ‘bad’ LDL cholesterol and decreases the levels of ‘good’ HDL cholesterol in your body, which increases your risk of developing heart disease and stroke. Trans fats is also associated with a higher risk of developing type 2 diabetes. Trans fats can be found in many foods such as in butter, margarine (in small amounts), deep-fried and processed foods like doughnuts, cakes and pastries. Baked goods, such as pastries, pizza dough, frozen pizza, pie crust, cookies, biscuits, and crackers also can contain trans fats.

Since 2006, the FDA has required trans fat content to be listed on the Nutrition Facts panel of packaged foods. In recent years, many major national fast-food chains and casual-dining restaurant chains have announced they will no longer use trans fats to fry or deep-fry foods.

The American Heart Association recommends that adults who would benefit from lowering LDL cholesterol eliminate trans fat from their diet.

To find the amount of trans fats in a particular packaged food, look at the Nutrition Facts panel. Companies must list any measurable amount of trans fat (0.5 grams or more per serving) in a separate line in the “Total Fat” section of the panel, directly beneath the line for “Saturated Fat.” This means if a food package states 0 grams of trans fats, it might still have some trans fats if the amount per serving is less than 0.5 g. You can also spot trans fats by reading ingredient lists and looking for the ingredients referred to as “partially hydrogenated oils.”

Eat foods with less phosphorus and potassium

When your kidney function starts to decline, the potassium levels in your blood may start to increase and you may be advised to follow a low potassium diet in order to help reduce it to a safe level. Not all kidney patients need to follow a low potassium diet and it is important not to restrict yourself unless you have been advised by a qualified health professional. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood, and you can work with your dietitian to adjust your meal plan. Your renal dietician can advise you how to follow a low potassium diet while making sure your diet stays balanced, nutritious and tasty.

Normal serum concentrations of potassium range from about 3.6 to 5.0 mmol/L and are regulated by a variety of mechanisms ²⁵. Hyperkalemia is defined as serum potassium level of more than 5 mmol/L in adults, more than 5.5 mmol/L in children, and more than 6 mmol/L in neonates ²⁶. Hypokalemia is defined as serum potassium level less than 3.6 mmol/L ²⁷.

Choose foods and drinks with less phosphorus

Phosphorus is a mineral contained in each cell in your body. Most phosphorus is in your bones and teeth, and some is in your genes (DNA and RNA) ²⁸. In humans, phosphorus makes up about 1 to 1.4% of fat-free mass. Of this amount, 85% is in bones and teeth, and the other 15% is distributed throughout the blood and soft tissues ²⁸. Your body needs phosphorus to make energy and to carry out many important chemical processes. In the form of phospholipids, phosphorus is also a component of cell membrane structure and of the body’s key energy source, ATP. Many proteins and sugars in the body are phosphorylated. In addition, phosphorus plays key roles in regulation of gene transcription, activation of enzymes, maintenance of normal pH in extracellular fluid, and intracellular energy storage ²⁹.

When you have chronic kidney disease (CKD), phosphorus can build up in your blood. Too much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break. High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain. Most people with chronic kidney disease (CKD) need to eat foods with less phosphorus than they are used to eating. Your health care provider may talk to you about taking a phosphate binder with meals to lower the amount of phosphorus in your blood. A phosphate binder is a medicine that acts like a sponge to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into your blood. Instead, your body removes the phosphorus through your stool.

Many different types of foods contain phosphorus, mainly in the form of phosphates and phosphate esters ²⁸. However, phosphorus in seeds and unleavened breads is in the form of phytic acid, the storage form of phosphorus ³⁰. Because human intestines lack the phytase enzyme, much phosphorus in this form is unavailable for absorption ²⁸. Phosphorus undergoes passive absorption in the small intestine, although some is absorbed by active transport ³⁰.

Phosphate can be measured in both serum and plasma ³¹. In adults, normal phosphate concentration in serum or plasma is 2.5 to 4.5 mg/dL (0.81 to 1.45 mmol/L) ³¹. Hypophosphatemia is defined as serum phosphate concentrations lower than the low end of the normal range, whereas a concentration higher than the high end of the range indicates hyperphosphatemia. However, plasma and serum phosphate levels do not necessarily reflect whole-body phosphorus content ³².

• Phosphorus is found naturally in foods rich in protein, such as meat, poultry, fish, nuts, beans, and dairy products. Phosphorus is also added to many processed foods.
• Many packaged foods have added phosphorus. Look for phosphorus—or for words with “PHOS” on ingredient labels.
  • Examples of foods that may have added phosphorus:
    • Fresh and frozen uncooked meats and poultry
    • Chicken nuggets
    • Baking mixes
    • Frozen baked goods
    • Cereals, cereal bars
    • Instant puddings and sauces
• Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh meats without added phosphorus.

Foods Lower in Phosphorus:

• Fresh fruits and vegetables
• Breads, pasta, rice
• Rice milk (not enriched)
• Corn and rice cereals
• Light-colored sodas/pop, such as lemon-lime or homemade iced tea

Foods Higher in Phosphorus:

• Meat, poultry, fish
• Bran cereals and oatmeal
• Dairy foods
• Beans, lentils, nuts
• Dark-colored sodas/pop, fruit punch, some bottled or canned iced teas that have added phosphorus

To lower the phosphorus in your diet, eat smaller portions of foods high in protein at meals and for snacks.

• Meat, poultry, and fish: A cooked portion should be about 2 to 3 ounces or about the size of a deck of cards.
• Dairy foods: Keep your portions to ½ cup of milk or yogurt or one slice of cheese.
• Beans and lentils: Portions should be about ½ cup of cooked beans or lentils.
• Nuts: Keep your portions to about ¼ cup of nuts.
• Eat fresh fruits and vegetables—if you have not been told to watch your potassium

Choose foods with the right amount of potassium

Potassium is a mineral found in many foods. Your body needs potassium for almost everything it does, including proper kidney and heart function, muscle contraction, and nerve transmission. Potassium is absorbed via passive diffusion, primarily in the small intestine ³³. About 90% of ingested potassium is absorbed and used to maintain its normal intracellular (inside the cell) and extracellular (outside the cell) concentrations ³⁴. Potassium is excreted primarily in the urine, some is excreted in the stool, and a very small amount is lost in sweat. The kidneys control potassium excretion in response to changes in dietary intakes, and potassium excretion increases rapidly in healthy people after potassium consumption, unless body stores are depleted ³³. The kidneys can adapt to variable potassium intakes in healthy individuals, but a minimum of 5 mmol (about 195 mg) potassium is excreted daily in urine ²⁵. Problems can occur when your blood potassium levels are too high (hyperkalemia) or too low (hypokalemia). Damaged kidneys allow potassium to build up in your blood (hyperkalemia), which can cause serious heart problems. Your food and drink choices can help you lower your potassium level, if needed. Some medicines also can raise your potassium level. Your health care provider may adjust the medicines you take. Individuals at risk of hyperkalemia should consult a physician or registered dietitian about appropriate potassium intakes from all sources. Although hyperkalemia can be asymptomatic, severe cases can cause muscle weakness, paralysis, heart palpitations, paresthesias (a burning or prickling sensation in the extremities), and heart rhythm problems (heart arrhythmias) that could be life threatening ³⁵.

• Salt substitutes can be very high in potassium. Read the ingredient label. Check with your provider about using salt substitutes.
• Fruit and vegetables are a known high source of potassium, however the types chosen and how they are prepared and cooked can impact on their potassium content.
• Drain canned fruits and vegetables before eating.
• *Potassium level is based on one serving.
  • One serving of fruit is one small piece; ½ cup fresh, canned, canned, or cooked fruit; ¼ cup dried fruit; or ½ cup juice.
  • One serving of vegetables is ½ cup fresh or cooked vegetables, 1 cup raw leafy vegetables, or ½ cup juice.

Fruits and Vegetables Lower in Potassium (200 mg or less*)

• Fruits:
  • Apples/apple juice/applesauce
  • Apricots (canned)/apricot nectar
  • Berries
  • Cranberry juice
  • Fruit cocktail
  • Grapes/grape juice
  • Grapefruit/grapefruit juice
  • Honeydew melon
  • Lemons and limes
  • Mangoes
  • Papayas
  • Pears
  • Peaches
  • Plums
  • Pineapple
  • Rhubarb
  • Tangerines
  • Watermelon
• Vegetables:
  • Alfalfa sprouts
  • Bell peppers
  • Bamboo shoots (canned)
  • Broccoli (fresh)
  • Cabbage
  • Carrots
  • Cauliflower
  • Celery and onions (raw)
  • Corn
  • Cucumber
  • Eggplant
  • Green beans
  • Kale
  • Lettuce
  • Mushrooms (fresh)
  • Okra
  • Summer squash (cooked)

Foods Lower in Potassium:

• Apples, peaches
• Carrots, green beans
• White bread and pasta
• White rice
• Rice milk (not enriched)
• Cooked rice and wheat cereals, grits
• Apple, grape, or cranberry juice

Foods Higher in Potassium:

• Oranges, bananas, and orange juice
• Potatoes, tomatoes
• Brown and wild rice
• Bran cereals
• Dairy foods
• Whole-wheat bread and pasta
• Beans and nuts

Even with a potassium restriction, two portions of fruit, such as an apple and an orange and two portions of vegetables, such as two heaped tablespoons each of carrots and broccoli, are allowed daily. Avoiding known higher sources and preparing them in the right way, helps you to maintain a safe potassium level within your blood.

Tips on making low potassium choices when eating fruit and vegetables:

• Boil potatoes and vegetables in a large amount of water. Three egg sized potatoes are a suitable portion if following a low potassium diet.
• Make sure they are well cooked, double boiling is NOT necessary.
• Avoid using cooking water to make sauces, soups,casseroles or gravy
• Parboil potatoes if wanting to fry, mash, chip or roast
• Parboil vegetables before adding to sauces or casseroles. Be sure to throw away the boiling water first!
• Avoid using a pressure cooker, microwave, steamer or stir-frying
• If wanting to include fruit juice, one portion of fruit can be swapped for 120ml of fruit juice
• If you enjoy salad, a handful counts as one portion from your vegetable allowance (if given one). Do not exceed one portion of salad per day if you are on a low potassium diet.
• Half a standard can of tomatoes (i.e. approx. 200g/8oz) can be swapped for one portion of potatoes, as long as the juice is drained and thrown away.
• If vegetables are preferred over fruit or vice versa, one portion can be swapped for the other.

How do I lower potassium in my diet?

• Eat smaller portions of foods high in protein at meals and for snacks: meat, poultry,fish, beans, dairy, and nuts.
• Use spices and herbs in cooking and at the table. Salt substitutes often contain potassium and should not be used.
• Potassium chloride can be used in place of salt in some packaged foods, like canned soups and tomato products. Limit foods with potassium chloride on the ingredient list.
• Drain canned fruits and vegetables before eating.
• Choose fruits and vegetables that are lower in potassium. Have very small portions of foods that are higher in potassium, like one slice of tomato on a sandwich, a few slices of banana on cereal, or half of an orange.
• If you have diabetes, choose apple, grape, or cranberry juice when your blood sugar goes down.

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