If You Have Stage 3 Kidney Disease, The Renal Diet Is Not For You

Suppose you have just left your primary care doctor’s office with a new diagnosis of Stage 3 Chronic Kidney Disease (CKD). Because you have been managing your diabetes and high blood pressure fairly well over the last ten years, the diagnosis comes as a shock.

That evening, you decide to make some dietary changes to benefit your kidneys. You have done this before with your diabetes and your high blood pressure. Over the last few years, perhaps you lowered your HgbA1c by cutting out simple carbohydrates, opting for whole grain toast, oatmeal and wheat pancakes instead of white bread, biscuits and grits. And maybe your blood pressure has come down as well as you have incorporated a plethora of vegetables and fruits into your daily diet. You feel better, you have lost some weight and you are ready to tackle your kidney disease the same way.

You google kidney diet and the “renal diet” pops up.

A quick glance at the list and your head starts to spin.

Substitute white bread for whole grain toast. Say what?

No more spinach or collard greens, no oranges or tomatoes. Huh?

Ditch the oatmeal and banana. You think, “What am I supposed to eat for breakfast? Milk and cereal?”

“Wait, I can’t have that either?”

You try hard to make this diet work, but it becomes impossible to balance the low potassium and low phosphorous requirements of the renal diet with the recommendations of the diabetic diet.

As a nephrologist, I see this scenario monthly. Since our practice often has a three-month lag time between a referral and the first office visit, my patients often struggle unnecessarily with the renal diet and all of its contradictions before I can help them. How do I help them? I give them the greatest news of all, “The renal diet is not for you.”

And not only is the renal diet not for most people with Stage 3 Chronic Kidney Disease, it often doesn’t apply to many people with Stage 4 disease. In fact, trying to adhere to a renal diet at these stages of kidney disease is more likely to cause problems then to help prevent the kidney disease from progressing.

Confused yet?

The traditional renal diet was developed for a very specific population of individuals, those people with kidney disease who have high potassium and high phosphorous levels in their blood, and traditionally those who are on hemodialysis. And, if you’re not careful or end up on a website with incorrect information, you may end up limiting your diet in ways that are not necessary for you. For example, even though your kidneys may not filter everything perfectly, they still may adequately filter potassium and phosphorous.

If you have been told you have stage 1-4 kidney disease by your primary care doctor, don’t jump right into a renal diet. Talk to a dietitian about your labs. Ask your nephrologist to review your medications, your potassium level and your phosphorous level to see whether or not you need to limit certain foods that contain high amounts of these elements.

The recommended diet to prevent progression of your chronic kidney disease will depend on many aspects of your health, including whether or not you have diabetes and hypertension, your medications, your heart function, your electrolyte levels and others. Your dietitian or doctor should also incorporate your lifestyle, likes and dislikes and socioeconomic status when designing your optimal diet.

So, unless you’ve been told specifically to avoid potassium rich foods by your doctor, or that your potassium level runs high, don’t limit these foods. Adding this level of stress to an already complicated disease management is unnecessary and confusing. And, it may do more harm than good to avoid potassium rich foods, including some fruits, vegetables and nuts, which are often the staples of a healthy diet.

For most people, this is great news. The renal diet is confusing, restricting and stressful.

However, for a small number of people, the recommendation to steer clear of the renal diet comes with shock and anger. In fact, one of the only times I have been fired by a patient is by insisting that her Stage 3 Chronic Kidney Disease did not require the renal diet. She was adamant that it applied to her and furious that I didn’t see things her way.

At the time, I felt angry that she fired me, and self-righteous because my patient thought she knew more about kidney disease than I did. Looking back, I realize that I mishandled the situation by not understanding her point of view.

Even though this woman’s kidney disease was mild, she was determined to adjust her eating habits to manage her kidney disease. Instead of dismissing her request for dietary changes, I should have tried harder to guide her dietary habits towards the DASH diet (Dietary Approaches to Stop Hypertension), or at least given her some recipes or guidance for early kidney disease eating, even it didn’t fit in with the traditional renal diet.

When I first wrote this blog post years ago, I didn’t have great resources to give patients to explain the difficult situation they were in. Now, I have my book. I’ve taken all of the information I’ve learned over the years and poured my heart and soul into The Cooking Doc’s Kidney Healthy Cooking, A Modern 10-Step Guide to Preventing and Managing Kidney Disease.