Diet guidelines for kidney disease often cause confusion because the same guidelines don't apply to everyone. Your diet needs and restrictions depend on your current stage of chronic kidney disease, lab results, and any other medical diagnoses or health issues you might have. Even though a person's diet for kidney disease requires individualization, it's easy to believe the myth that the same guidelines apply to everyone. Read on to help debunk some common kidney diet misconceptions.
1.  Your diet has to be bland.
People with chronic kidney disease often need to restrict their sodium intake. While salt is a commonly used flavor booster in cooking, removing added salt doesn't mean you must have a bland diet forever.
Experiment with some of these kidney-friendly flavor options if your food feels too boring:
- Add a squeeze of lemon or lime juice after cooking foods, especially on proteins and vegetables.
- Shake some crushed red pepper flakes on anything that needs some spice.
- Try a seasoning blend without added sodium. Common grocery store options without salt include lemon pepper, garlic and herb, and Italian blends.
- Choose onion and garlic powders instead of onion or garlic salt for cooking. Add fresh onion and garlic to your home-cooked meals for deeper flavor.
- Bread meats at home with panko bread crumbs and no-added sodium seasoning blends, then bake them in the oven. This method will make a crunchy crust without using a batter mix that's likely too high in sodium.
- If you like pickles, try quick pickling hot peppers or cucumbers at home with vinegar, fresh herbs, and spices for a quick sour flavor boost to enjoy on the side of your meals.
2.  You can't eat fruit.
While many fruits are high in potassium, fruit is still part of a healthy kidney diet. The number of servings per day of fruit you should eat - even of lower potassium fruits - will vary depending on your diet needs, but some fruit can fit into your day.
When eating fruit, it's essential to be mindful of serving sizes. For example, a small apple or orange is the size of a tennis ball, and banana sizes range greatly. For chopped fruits or berries, ½ cup is usually the serving size, so try to use a measuring cup to memorize what one serving looks like. Also, note that a serving of fruit juice is usually 8 ounces, and this might be less than you're used to drinking at a time.
Lower potassium fruits include:
- Apples
- Blackberries
- Blueberries
- Fruit cocktail
- Pineapple
High-potassium fruits and fruit juices include:
- Jackfruit
- Guava
- Passionfruit
- Kiwi
- Oranges
- Bananas
- Prune juice
- Cantaloupe
3.  You can't eat plant proteins because there's too much phosphorus.
Plant-based proteins are often sources of phosphorus, but the type of phosphorus in plants is less bioavailable than in animal proteins. This means that the body absorbs less phosphorus from the plant protein than it would from a serving of food with the same amount of phosphorus but with higher bioavailability.
Plant-based protein sources include:
- Beans
- Lentils
- Nuts and seeds
- Tofu
- Tempeh
- Whole grains
Some people worry that plant proteins aren't high enough quality for people with kidney disease. However, this belief has been debunked, and plant proteins may even have some added benefits for people with kidney disease.
4.  You should only eat white carbs to keep your phosphorus levels low.
It's true that white carbohydrate choices, like white rice, white bread, and pasta, are generally low in phosphorus. While this is accurate, it's likely safe to incorporate a few servings of whole grains per day, and whole grains could help improve your health.
In addition to their phosphorus content being less bioavailable than animal-based foods, many plant-based sources of carbohydrates and protein – especially beans, lentils, and whole grains – are good sources of dietary fiber and other micronutrients. Most people don't consume enough fiber daily. Fiber has many health benefits, such as improving digestive health, lowering cholesterol, and helping control blood sugar.
Instead of trying to eat only white carbs, another tactic to reduce phosphorus intake is to lower your intake of phosphorus additives. To do this, read the nutrition ingredients on food labels and avoid foods that contain the root "phos," such as:
- Phosphoric acid
- Trisodium phosphate
- Monosodium phosphate
- Disodium phosphate
5.  Everyone with CKD needs a fluid restriction.
As kidney disease advances, the kidneys filter excess fluid out of the blood less efficiently, so fluid restrictions are often necessary. Fluid restrictions depend on many factors, such as how much urine a person makes and how much kidney function is left.
Fluid restrictions generally start at later stages of chronic kidney disease, like stage 4 or 5, though this may differ for people with heart disease. A healthcare provider might encourage people in the early stages of kidney disease to drink more water and fluids, depending on their usual intake. Patients on dialysis usually have a fluid restriction because there's a limit to how much fluid can safely be removed during each dialysis session.
6.  There's one type of diet for people on dialysis.
Though dialysis helps filter your blood, most people on dialysis still require some diet restrictions. Recommendations vary based on each individual's needs, and there isn't only one recommended diet or nutrition plan for people on dialysis
When on dialysis, patients are typically recommended some combination of fluid, sodium, potassium, and phosphorus limits. If you’re on dialysis or starting soon, work with the registered dietitian at your unit to better understand your personal nutrition needs. Over time, restrictions may change based on your lab trends.
Bottom Line
As with most things diet-related, moderation is key. You can eat whole grains, plant proteins, and fruits as part of a healthy kidney diet, but you still need to consider serving sizes and total servings per day of these foods. Always check with your own healthcare provider or team to determine if any diet changes you're considering making are appropriate for your current stage of kidney disease.
