Submitted by Fiona Bellefeuille RD, CDE
Dairy products have many health benefits. However, for people with kidney disease they can be a significant source of potassium, phosphorous and sodium. This may be problematic depending on your stage of kidney disease and your lab values. For example, in the early stages you may not need to limit your potassium and phosphorous intake, therefore dairy products would likely not be restricted. As kidney disease progresses, your blood levels of potassium and phosphorous can rise. At this point, your dietitian may advise you to limit your intake of potassium and phosphorous rich foods, including dairy products.
Fortunately, there are many plant-based alternatives for you to try. Choosing kidney- safe products can be challenging as some manufacturers of plant-based alternatives include potassium, calcium, sodium and phosphorous additives to match their dairy counterparts. These additives are more absorbable by the body than those minerals found naturally in dairy products. This means that some plant-based milks and cheeses may have similar amounts of potassium, phosphorous and sodium as their equivalent dairy products. Brands will also change their recipe from time to time, so a plant-based alternative that was safe one week may have added potassium or phosphate the next time you purchase it. The following guide will help you navigate the dairy alternative aisles at the store to choose kidney-friendly products.
Nutrition Labels
The nutrition label is a good place to start when choosing a kidney friendly product. Canadian companies do not have to list potassium or phosphorous so you may not always find this information available. If you are trying to follow a low-potassium diet, look for potassium that is less than 3 % of the recommended intake or less than 150 mg of potassium per serving. If phosphorous is listed, look for products with less than 5% (63 mg) per serving. As well, choose food items with less than 5% sodium or less than 150 mg of sodium per serving. See the nutrition label below.
Additives
Check the ingredient list for harmful additives. Look for the words ‘potassium’ or ‘phosphate’ –if either of these is listed, it is best you avoid the product as it may be high in potassium and phosphorous due to the additives. Some common additives include:
- Potassium citrate
- Potassium chloride
- Dipotassium phosphate
- Sodium phosphate
- Calcium phosphate
This is an example of two almond milk products – one with additives, one without:
Choose the first product because it does not contain any potassium or phosphate additives. Avoid the second product as it contains both a potassium and a phosphate additive.
Milk Alternatives
We are lucky to have many types of milk alternatives to choose from. Almond, rice, soy, cashew, coconut, and oat milks are some common ones. Each variety also comes with a selection of options such as sweetened, unsweetened, original, refrigerated, shelf stable, as well as different flavours like vanilla and chocolate. Flavoured and rice milk alternatives tend to be high in sugar and may need to be limited for those watching their sugar intake. Chocolate versions may be significantly higher in potassium and phosphorous due to the chocolate content.
Potassium content varies among milk alternatives; soy and oat milks tend to be naturally high in potassium whereas unfortified nut milks tend to be lower in potassium. Although nuts are high in potassium and phosphorous, the nut meal – which contains the greatest amount – is discarded during the nut milk-making process. This generally creates a product that is low in these minerals and therefore acceptable for a low potassium and a low-phosphorus diet.
If you are following this type of diet, check the nutrition information and ingredient list of milk alternatives to find a product that is low in both minerals.
Cheese Alternatives
Dairy cheese is high in phosphorous and sodium, therefore it is often restricted on a kidney diet. There are many non-dairy or vegan cheeses available in grocery or health food stores. Follow the above guidelines for assessing the nutritional label and ingredient list to ensure that the product you are choosing is kidney friendly. Some cheese alternatives can have as much phosphorous and sodium as dairy cheese due to additives. See the below label as an example:
Vegan cheese – note the phosphate additive in the ingredient list (tricalcium phosphate) and the sodium content, which is above 150 mg and 5%. This cheese alternative would not be recommended.
The Bottom Line
Just because a product is available in a health food store, or claims to be vegan or plant-based does not necessarily mean that it will be kidney-friendly. Choosing a non-dairy alternative for milk or cheese can be really challenging. Ask your renal dietitian for product suggestions and remember to always read the nutrition label and ingredient list to ensure that the product is safe for you to consume.