Choosing a plant-based diet with CKD
Eating a plant-based diet doesn’t mean you have to become vegan or vegetarian, it simply means eating more plant foods and fewer animal foods.
For a plant-based diet to be healthy, you should also limit the amount of processed foods you include, such as white breads, sugary cereals, crisps, biscuits, cakes, convenience foods, sugary drinks and plant-based sausages or burgers.
Common plant-based diets you may have heard about include vegetarian and vegan diets, the traditional Mediterranean diet and the balanced diet recommended by the Eatwell guide in the UK.
If you already eat or decide to start eating a fully plant-based diet (no animal foods), speak to a kidney dietitian for personalised advice and to ensure you are getting all the nutrients you need.
What are the benefits of a plant-based diet?
Plant-based diets are beneficial for many conditions that commonly accompany CKD, such as diabetes, high blood pressure, high cholesterol and cardiovascular disease.
They can also help with weight control as plant-based diets tend to be high in fibre (so they are more filling) and lower in fat and sugar.
Plant proteins such as beans and lentils are also cheaper to buy than meat and fish.
Finally, plant-based diets are more sustainable, so they're good for you, for your wallet, and for the planet!
Can I eat a plant-based diet if I have CKD or have had a kidney transplant?
Yes – in fact, a plant-based diet may even be beneficial as it may help to lower your blood pressure and cholesterol and help to maintain or achieve a healthy weight.
Plant-based diets may also lower your risk of developing cardiovascular disease and diabetes and even help manage your diabetes if you already have this condition.
Can I eat a plant-based diet if I’m having dialysis?
Yes! However, it’s important to ask your kidney dietitian for personalised advice. This is because dialysis can sometimes result in malnutrition.
Malnutrition is when the body isn’t getting enough of the nutrients it needs, which can lead to a loss of muscle, low energy, and feeling weak. This can be caused by the dialysis process, which removes valuable protein in the body. It’s important that these proteins are replaced in the diet. Plant-based diets are often lower in protein than animal sources, so you need to ensure you are eating enough protein.
Potassium and plant-based diets for people with kidney disease
Potassium is a mineral that plays an important role within the body. It can be found in most foods, including both plant and animal foods. In addition, potassium is sometimes added to processed foods.
People with CKD can have too much potassium in their blood. This can cause an irregular heartbeat, which can be dangerous. For this reason, some people with CKD are advised to reduce the amount of potassium they eat .
If you have been advised to lower your potassium, then it’s important you speak to a kidney dietitian, who can give you personalised advice. This may involve modifying the foods you eat or adapting your cooking methods, but you should still be able to eat and enjoy a healthy plant-based diet with plenty of vegetables, fruits and wholegrain foods.
In the past, people following a low potassium diet were advised to cut down on many fruits and vegetables and eat white varieties of bread, pasta and rice. We now know that the health benefits of eating wholegrain varieties of these foods far outweigh any perceived risks. Recent research also suggests that eating a plant-based diet can actually help to lower potassium.
Phosphate and plant-based diets for people with kidney disease
Phosphate is also a mineral found naturally in protein foods and wholegrain foods. It is also added to many processed foods as an additive.
Phosphate is used by our body, along with calcium, to maintain healthy bones.
A common feature of CKD is having too much phosphate in the blood. Over time this can damage the bones and blood vessels. If the levels of phosphate in your blood become high, you may be advised to reduce phosphate in your diet or take medication called a phosphate binder.
Plant-based diets can be naturally lower in phosphate. This is because we absorb less phosphate from plant foods than we do from animal foods and plant foods.
Is a plant-based diet low in salt?
That depends on what you choose to eat!
Using less salt and eating fewer salty foods is extremely important at any stage of CKD.
It is recommended that adults consume no more than 5g of salt a day (roughly one teaspoon). The majority of salt in our diets comes from processed foods (cakes, biscuits, crisps, sauces, condiments, tinned foods, processed meats and meat alternatives and ready prepared meals).
Eating a plant-based diet that contains fewer processed foods will likely mean more home-cooked foods. Cooking at home means you’re in control, so it’s a great way to lower your salt intake, providing you’re not adding salt at the table! Find recipes and inspiration on cooking without salt on the Kidney Kitchen website.
I have CKD. What can I eat on a plant-based diet?
Fruit and vegetables
Fruit and vegetables should make up over a third of the food we eat each day. Aim to eat at least five portions.
- One portion is approximately the size of the palm of your hand (80g).
- Fruit juice or smoothies count as only one portion and should be limited to 150ml a day.
- Dried fruit should be limited to 30g a day.
Avoid star fruit, which contains a toxin that can build-up in the body and become harmful to people with CKD.
If you have received a transplant, avoid grapefruit and grapefruit juice, pomelo, pomelo juice and star fruit as they can affect the level of medication in your blood.
If you need to lower your potassium level, you may need to limit some high potassium fruits and vegetables and replace them with low potassium alternatives. Seek guidance from a kidney dietitian to discuss if this is necessary and for advice to ensure you still eat plenty of fruits and vegetables.
Starchy carbohydrates and wholegrains
Base your meals around wholegrains:
- potatoes or yams (with the skins if possible)
- wholegrain bread and chapattis
- wholegrain breakfast cereals (low in salt, sugar, and fat)
- wholegrain or wild rice
- wholegrain pasta and noodles
- oats or other starchy and less processed grains such as millet, quinoa, buckwheat, wholegrain couscous, or bulgur wheat.
Low-fat dairy and dairy alternatives
Swap your dairy milk or yoghurt for a plant-based alternative – there are lots to choose from. Consider low-fat dairy or dairy alternative milks, such as skimmed, 1% or semi-skimmed milk, and unsweetened almond, oat, soya, or rice milk with added calcium.
Be aware that some dairy alternatives contain phosphate additives so you may want to talk to a kidney dietitian about the best option for you.
Choose low-fat plain dairy yoghurt, or a plain soya, oat or almond yoghurt. Flavour it with fruit (fresh, tinned, stewed), vanilla extract, or cinnamon rather than sugar.
Hard cheese is a processed food and contains high amounts of fat and salt so try not to eat it every day, and consider the reduced fat or low-fat options. Remember, dairy-free cheese alternatives are also highly processed and will contain a high amount of salt and fat.
Beans, peas, chickpeas and lentils are a good alternative to meat because they’re naturally low in fat and high in fibre, protein, vitamins and minerals. Tofu, tempeh, and mycoprotein are also vegetable-based sources of protein
Nuts and seeds are also a source of healthy protein, but it's best to choose plain unsalted.
Meat and poultry: if you still eat these, choose lean cuts of meat, unsalted and unsmoked fish, and keep red meat and processed meat to a minimum (less than 70g a day).
Fish / Omega-3: it is recommended that you include a source of omega-3 such as oily fish (salmon, mackerel, sardines or herring) in your diet twice a week. If you don’t eat fish, a small amount of walnuts, chia seeds, ground flaxseeds or hemp seeds daily will help to ensure your body has enough healthy fats.
Meat substitutes such as vegetarian burgers, sausages, meatballs, and sausage rolls are highly processed and will most likely be high in salt and fat. This doesn’t mean you should never have them, just don’t eat them every day.
Choose vegetable-based oils and spreads, and only eat in small amounts. Olive oil or rapeseed oil are good options.
Kidney-friendly plant-based food swaps
If you’re keen to eat more plant foods but aren't sure where to start, try making a few food swaps:
- Replace sugary breakfast cereals with oats or a wholegrain cereal low in salt and sugar
- Replace white bread, rice, or pasta with wholegrain alternatives.
- Try making some meat swaps. For example, swap a beef burger for a Kidney Kitchen bean burger.
- Replace your beef spaghetti Bolognese for Kidney Kitchen lentil Bolognese.
- Swap your chicken curry for a Kidney Kitchen Butternut squash and chickpea curry
- Try some new vegetarian recipes such as the Kidney Kitchen North African One-Pot Casserole or Vegetable crumble.
- In a Cottage or Shepherd’s pie, consider replacing all or even just half of your meat with red lentils
- Add fruit and vegetables to every meal, such as fruit on cereal, salad in sandwiches and vegetables with main meals. Enjoy fruit or vegetables as snacks.
Eating a plant-based diet doesn’t mean you have to completely give up all animal foods, it means choosing more healthy plant foods that can benefit both your health and the environment.
Look through our hundreds of Kidney Kitchen recipes and enjoy!
For more advice about plant-based diets from the Kidney Kitchen renal dietitians listen to the Diary of a Kidney Warrior podcast, episodes 65 (Plant-based diets and early CKD and transplants) and 74 (Plant-based diets and dialysis).