According to the Centers for Disease Control, as many as 1 in 3 people with diabetes may have chronic kidney disease (CKD). Over time, high blood sugar from diabetes can cause damage to the blood vessels in the kidneys, which may lead to chronic kidney disease. For people with diabetes (type 1 or type 2) and chronic kidney disease, nutrition and lifestyle goals include controlling blood pressure, keeping blood sugar in the goal range most of the time, and managing cholesterol levels. Learn strategies below to help meet these health goals with good nutrition habits, exercise, and other lifestyle changes.
Nutrition
Though what you eat will require extra thought when you have diabetes and chronic kidney disease, the overarching goal for both conditions is a generally healthy diet and balanced nutrition. A healthy, balanced diet for most people includes complex carbohydrates, sources of protein, and healthy fats. Many of the same nutrition principles apply to both diabetes and CKD management, as noted below:
Include produce, whole grains, and legumes
People with diabetes often have to monitor their carbohydrate intake to help manage their blood sugar. When people with diabetes have chronic kidney disease, they may also have to limit potassium and phosphorus. Though carbohydrate-rich foods are sources of both phosphorus and potassium, they should still be included in the diets of people with CKD and diabetes, within prescribed limits.
To help manage blood sugar, aim for complex carbohydrates as much as possible. Besides carbohydrates, these foods contain natural sources of nourishing nutrients such as fiber, vitamins, and minerals. Include these foods in your diet where possible, but monitor serving sizes and the number of servings per day, especially if you have kidney diet restrictions on top of monitoring your blood sugars.
Appropriate complex carbs for people with diabetes include:
- Fruits
- Non-starchy vegetables, like green beans, cabbage, peppers, carrots, celery
- Legumes, including peas, beans, lentils
- Whole grains, such as whole wheat products, brown rice, quinoa, bulgur
Limit added sugar
Though you should continue to eat complex carbs when you have diabetes and CKD, try to limit your intake of simple sugars and highly refined carbs. Too much simple sugar can make your blood sugars harder to control, and these foods also don't contain the same nutrient value as more complex carb foods. Simple sugars are found in soda, candy, cookies, cakes, juices, pastries, and sweetened teas.
Watch your sodium intake
People with CKD often have sodium restrictions even if they don't have diabetes, but it's especially important to monitor if you have CKD and diabetes. A joint report from Kidney Disease: Improving Global Outcomes and the American Diabetes Association Guidelines recommends a low-sodium diet for people with diabetes and CKD to help control blood pressure and reduce cardiovascular risk. In this report, the recommended sodium intake ranges from ~1500 - 2300 milligrams per day.
To help limit sodium, make food from home as much as possible so you know what's in your food. Remember that condiments, like hot sauces, teriyaki, soy sauce, and salad dressings, often have high sodium content. Processed meats, such as bologna, salami, bacon, and hot dogs, are also sneaky sources of sodium.
Eat good sources of protein
Protein is an essential nutrient. It helps build and repair muscles, heal wounds, and control blood sugar. Protein needs vary depending on which stage of CKD a person is in. Check with a healthcare provider to determine how much protein they recommend you eat daily.
In general, it's a good idea to spread protein throughout the day when you have diabetes because it helps stabilize blood sugar. Good protein sources include lean meats, poultry, fish and seafood, tofu, beans, and eggs.
Choose healthy fats
People with either CKD or diabetes are at higher risk for heart disease, so the type of fats you eat matters. Healthier fat types are monounsaturated and polyunsaturated, and unhealthy fats are saturated and trans fats.
Better-for-you oil choices include olive, peanut, safflower, sesame, or canola oils. Avocados, nuts, seeds, and fatty fish (salmon, tuna, mackerel) are healthy fat sources.
Saturated fats are generally found in animal products, like poultry with the skin on, red meat, pork, and butter. Trans fats are sometimes found in vegetable shortening, baked goods, and fried foods. Limit fried foods and processed cakes, cookies, or pastries to eliminate some unhealthy fats.
Exercise
If you're physically able to exercise, guidelines suggest 150 minutes of moderate or vigorous physical activity per week. Ideally, you would break your exercise activities into smaller, manageable chunks, such as 30-40 minutes 4-5 times per week.
Remember that exercise can be fun. Examples of exercises you can do other than hitting the gym:
- Swimming
- Dancing
- Hiking to a pretty spot
- Walking with a friend to catch up
- Gardening
- Water aerobics
- Tennis
- Jumping rope
- Active play with kids or grandkids
Other lifestyle considerations
In addition to managing your diet and exercise, keep other lifestyle factors in mind when you have both CKD and diabetes. If you smoke cigarettes or use other tobacco products, all health organizations recommend stopping as soon as possible. Similarly, you should limit alcohol intake strictly or stop drinking alcohol for optimal health.
If you're currently considered overweight or obese, work towards a healthier weight range. Making healthy nutrition and exercise changes could help you lose weight over time, but consider working with a registered dietitian for individualized advice and support.
Even if you change your diet and increase physical activity, continue to take medications for diabetes, blood pressure, cholesterol, or kidney disease as prescribed by your healthcare provider.
Bottom Line
Chronic kidney disease and diabetes require thoughtful management of diet and exercise, but many of the same principles apply to both conditions. Review any significant diet and exercise changes with your healthcare provider to ensure they're healthy and safe for you.
