It can be challenging enough to follow a renal diet or diabetic diet, but a renal diabetic diet? It can be so confusing with all the things to avoid with diabetes and kidney disease. Here, we will dive into what to know about the renal diabetic diet.
According to the CDC, one in every three American adults with diabetes also has chronic kidney disease. That is tens of thousands of people, all of whom are now dealing with not one but two challenging diseases, each of which has its guidelines, restrictions, and recommendations in regards to diet and lifestyle.
But, with the right understanding of both conditions and the dietary options needed to manage them, implementing a renal diabetic diet doesn’t have to be a stressful experience.
About Kidney Disease & Diabetes
Starting a renal diabetic diet begins with understanding chronic kidney disease, diabetes, and how these two conditions can be related.
There are two main types of diabetes, type 1 and type 2.
In type 1 diabetes, the body doesn’t produce insulin as it should. The sugar goes into the bloodstream, but not the cells. This can lead to dangerously low and high blood sugar levels. People with type 1 diabetes use prescription insulin to help their bodies use the carbs they need.
With type 2 diabetes, the body doesn’t respond well to insulin in the body. This can lead to high blood sugar and other potential complications. People with type 2 diabetes are often prescribed oral medication and insulin to help use the carbs they need.
The Diabetic Diet
For people with diabetes, the main priority is to track carbohydrates in their diet. The amount of carbohydrates a person needs depends on factors such as age, gender, physical activity, and other health conditions.
A serving of carbohydrates equals 15 grams of carbs. Foods that have carbohydrates include;
- Starches like bread and bread products, pasta, rice, and cereal
- Fruits and fruit juices
- Starchy vegetables like potatoes, peas, and corn
- Dairy and dairy products like yogurt and cheese
- Sugar and sugary foods and beverages
And while many feel that a diabetic diet should be avoiding carbs, it’s important to include them in a diabetic diet.
In fact, by including more frequent, small meals, many with diabetes find better control of blood sugar spikes and dips. This is why it’s helpful to eat every 2-4 hours throughout the day.
Other factors in the diabetic diet include looking at fat and protein intake as well as micronutrients such as fiber, chromium, and magnesium.
Chronic Kidney Disease occurs when your kidneys are no longer able to filter as they should. There are different stages of CKD, with early stages and later stages differing based on how well your kidneys can filter waste.
Your estimated glomerular filtration rate (eGFR) measures the kidney filtration. Different eGFR levels corresponding to the different stages of CKD. Kidney function is also dependent on other factors such as age, genetics, and physical activity level.
The Renal Diet
A diet for chronic kidney disease is known as the renal diet. There are many different types of renal diets besides the diabetic renal diet.
Some examples include:
Some may need to follow multiple diet goals, like both a low protein and low potassium diet. This is what makes working with a dietitian so helpful. A dietitian will guide you through these multiple diet changes to help make sense of it all.
Foods to Eat in a Renal Diabetic Diet
While most diets that are beneficial for diabetes are great for the general public, focusing on lean meats and vegetables, these diets may not be right for someone with CKD. That’s because they don’t tend to take into account things like the amount of phosphorus or potassium in the diet, and may not account for sodium.
On a renal diabetic diet, there are more things to take into account than with a general diet for diabetes. That includes carbohydrates, proteins, fats, and nutrients like potassium.
As mentioned above, carbohydrates are extremely important and beneficial for a renal diabetic diet. Whole grains are excellent carb sources.
Fiber helps to manage blood sugar as high fiber foods cause a much lesser insulin response than does glucose. In general, those with diabetes and/or kidney disease should aim for 20 to 35 grams of fiber each day.
Prebiotics also aid in good digestion. Prebiotics feed the good bacteria in your gut and promote a healthy microbiome.
Lean and Plant Proteins
Protein is the building block of our muscles. However, protein recommendations vary greatly depending on the stage of kidney disease and overall kidney function.
That is why it is important to make sure you are focusing on a renal diabetic diet instead of simply a diet focused on managing diabetes when you’re dealing with both conditions.
There are certain markers of eGFR you can look for when determining how much protein to eat in a day. The chart below will help you decide what amount of protein is best for you. This is also a great opportunity to work with a registered renal dietitian. Dietitians are trained to make safe diet recommendations for you.
It is very important to work with a dietitian when following a low-protein diet (defined a less than 0.8 g/kg per day).
Some research has shown that limiting protein intake during the early stages of chronic kidney disease may lead to better overall outcomes in levels such as fasting glucose and eGFR.
Protein is found in both animal and plant-based foods. Examples of kidney-friendly protein sources from animals include lean beef, turkey, and chicken. Beware of pre-made roasted chicken as they often contain more sodium and phosphorus. Cottage cheese is a great protein option. It is lower in potassium and phosphorus than other food choices.
Plant-based protein options include tofu, lentils, beans, nuts, and nut butter. As with all processed protein options and food choices, be sure to limit sodium in these foods and all foods you choose.
Fats often get a bad name, but fats are essential for our body to function properly. Not only do they help to insulate our bodies, but they are also necessary for the formation of hormones and help to create healthy cells.
It’s also important to manage the type and amount of fat you’re consuming as part of a renal diabetic diet. While some fats can be beneficial, such as unsaturated fats discussed below, others, like excessive saturated fats or trans fats, can lead to increases in blood pressure, a dangerous condition for people with diabetes and chronic kidney disease.
Fats are organized into a few different categories, including saturated and unsaturated fats.
Saturated fats are solid at room temperature. They are in foods such as whole milk dairy, cheese, and baked goods.
Unsaturated fats, on the other hand, are liquid at room temperature and come from vegetables, nuts, seeds, and fish.
Unsaturated fats are organized into two groups. There are monounsaturated fats like avocados and olive oil. There are also polyunsaturated fats, found in fatty fish, walnuts, flax seeds, and sunflower oils.
Polyunsaturated fats are essential because our bodies can’t make them. Therefore we need to get them from our diets.
Two types of polyunsaturated fats, omega-3, and omega-6 fats are important for managing high cholesterol. High cholesterol is linked to diabetes and high blood pressure.
Polyunsaturated fats may decrease LDL cholesterol and help reduce blood pressure (omega-3) and protect against heart disease (omega-6). Some people even benefit from an omega-3 supplement.
Potassium is not limited in a diabetic diet. However, those on a renal diabetic diet should understand potassium.
This is because the kidneys may not be able to process the potassium in food as well with CKD. Therefore, limiting potassium intake is important for managing the disease.
When instructed by your physician, people with chronic kidney disease may need to aim for 3,000 mg to 4,000 mg of potassium per day. Those with end-stage renal failure should aim for between 2,000 mg and 3,000 mg potassium per day.
Common sources of potassium include dairy, nuts, fruits, and vegetables, all of which are great foods to include in your overall healthy diet in a way that fits your potassium needs.
Restricting potassium in a renal diabetic diet needs to be from your doctor or dietitian. But know that restricting doesn’t necessarily mean eliminating foods you enjoy.
Fruits and vegetables are still an option on a low potassium diet. Understanding the factors that affect your potassium is also important when choosing the right foods for you.
Table of Foods to Eat in a Renal Diabetic Diet
Below is a table of the different food groups to include in a renal diabetic diet.
|Food Group||Examples of Foods|
|Fruits (low potassium)||Apples, Applesauce, Apricots, Blueberries, Cherries, Cranberries, Fruit Cocktail, Grapes, Lemon, Lime, Mandarin Orange, Pear, Pineapple, Plum, Raspberries, Rhubarb, Strawberries, Tangerine, Watermelon|
|Vegetables (low potassium)||Asparagus, Arugula, Bamboo Shoots, Broccoli, Carrots, Cauliflower, Celery, Collard Greens, Cucumber, Eggplant, Green Beans, Kale, Lettuce, Mustard Greens, Onion, Peas, Peppers, Radicchio, Red Cabbage, Scallions, Summer Squash (like zucchini), Tomatillo, Water Chestnuts, White Mushrooms|
|Whole Grains||Whole grain pasta, Brown rice, Barley, Quinoa, Millet, Couscous, Amaranth, Brown rice, Wild rice, Whole wheat bread, bagels, and buns, Oats, Quinoa, Farro, Freekeh, Sorghum, Tapioca, Millet, Barley, Bulgur, Kamut, Durum, Buckwheat, Teff, Arrowroot, Wheat berries|
|Lean Proteins||Cottage Cheese, Egg, Tofu, Tuna, Pecans, Seitan|
|Healthy Fats||Olive oil, Avocado oil, Flaxseed & flaxseed oil, Sunflower oil, Safflower oil, Fatty fish like salmon and tuna, Walnuts oil|
|Drinks||Apple juice, Coconut Milk, Coffee, Cranberry juice, Ginger ale, Grape Juice, Lemonade, Oat Milk, Pineapple juice, Rice Milk, Tea, brewed|
Foods to Limit on a Renal Diabetic Diet
While a renal diabetic diet offers a lot of great options when it comes to food choices, some things should be limited or eliminated.
Sugar can be tough to limit because it often well hidden. Understanding sugars can make limiting and choosing the right foods a bit easier. The general recommendation for sugar is 6 teaspoons (25 grams) per day for women and 9 teaspoons per day (37.5 grams) for men.
Simple sugars are just that – sugars that are easy for our bodies to break down. These are found in foods such as white bread, white pasta, pastries, fruit juice, soda, or candy, which are known as refined carbohydrates.
These simple sugars have been linked to type 2 diabetes and should be limited as they are lacking in nutrients and fiber.
Fructose is another type of sugar, found in fruit. While fructose is still sugar, it is often found alongside fiber because it’s in fruit. Fiber helps manage blood sugar. For people managing their sugar, fruit can be a great option for something sweet.
Non-nutritive sweeteners are sugar substitutes that provide a sweet taste without increasing blood glucose or insulin concentrations. There are eight non-nutritive sweeteners currently approved by the FDA. Those include:
- Acesulfame Potassium (Ace-K)
- Aspartame (Nutrasweet, Equal, Sugar Twin)
- Neotame (Newtame)
- Saccharin (Sweet and Low, Necta Sweet)
- Luo Han Guo Fruit Extracts (Nectresse, Monk Fruit)
- Steviol glycosides (Stevia, Truvia, PureVia)
- Sucralose (Splenda)
When consumed in moderation, these sweeteners can fit into a renal diabetic diet. Ace-K has 10 milligrams of potassium per table side packet, which is negligible when consumed in moderation.
Sugar alcohols are another group of sweeteners that are found in a diabetic diet. Examples of sugar alcohols include:
These types of substitutes provide approximately half the amount of calories compared to regular sugar. However, excessive use can cause diarrhea.
While some fats are beneficial for our health, others are not. Saturated fats and trans fats are two types of fats that should be avoided in a renal diabetic diet.
Saturated fats are found in foods like red meat, whole milk, butter, and lard. Trans fats are found in commercially processed snacks and baked goods. These fats raise blood cholesterol and may not be beneficial for heart health.
Trans fats are fats that are created or found naturally in the diet. Examples of natural trans fats include animal meats and products like dairy.
Artificial trans fats are created to preserve foods as well as change taste and textures. The U.S. Food and Drug Administration stated trans fats are no longer considered Generally Recognized as Safe (GRAS) for humans.
As people with CKD are at an increased risk of heart attack or stroke, it’s ideal to opt for heart-healthy fats like monounsaturated or polyunsaturated fats instead.
Phosphorus is a mineral found in foods and our body. It pairs with calcium to help form our bones.
Organic phosphorus is found in food naturally. Examples of organic phosphorus can include chicken, fish, eggs, lentils, beans, and nuts. Inorganic phosphorus is a preservative found in processed food.
These additives can increase the levels of phosphorus in your blood. Too much phosphorus is dangerous.
Phosphorus additives are listed on ingredient labels. Examples include:
- Dicalcium phosphate
- Disodium phosphate
- Monosodium phosphate
- Phosphoric acid
- Sodium hexameta-phosphate
- Trisodium phosphate
- Sodium tripolyphosphate
- Tetrasodium pyrophosphate
Organic phosphorus is not something that is automatically limited in a diabetic diet, but it is something you need to be aware of as a patient with CKD.
Thankfully, many of the foods that have inorganic phosphorus additives are not a good source of nutrients, and should ideally be avoided in any healthy diet.
Phosphorus binders will be prescribed if phosphorus cannot be controlled through diet changes alone. Learn more about phosphorus binders here.
Limiting your sodium intake can be beneficial for your diabetes, your kidney disease, and your overall health. Sodium intake has been linked to high blood pressure, which is one of the main predictors of people with diabetes developing CKD.
Aim for 1,500 mg to 2,300 mg per day of sodium, depending on your disease and needs. Click here to learn about low-sodium snacks.
Work with a dietitian when deciding how much to limit your sodium intake. Very low sodium intake has been associated with impaired glucose metabolism and insulin sensitivity, two things that are a challenge for patients with diabetes.
One of the macronutrients, protein, has been tied to advanced kidney issues in later stages of CKD when not limited.
A meta-analysis in 2021 found that a low-protein diet in stages 1-3 CKD helped slow down the progression of CKD as well as reduce the amount of protein in the urine. It was also found that glucose and cholesterol levels were also improved with the low protein diet.
To follow a low-protein diet, it’s important to limit or avoid foods such as;
- Dairy and dairy products such as milk and cheese
While these foods can still be included, the amount of protein can add up quickly and often exceed the amount of protein safe for a renal diet.
Learn more about what a low-protein diet is here.
Table of Foods to Limit
Below is a table of the groups of foods that should be limited or avoided in a renal diabetic diet.
|Sugary foods and Drinks||Bakery goods, sodas (both regular and diet), sugar substitutes, candies and sweets|
|Unhealthy Fats||Trans fats (baked goods, crackers chips, cookies), saturated fats (fried foods, red meat, candies, whole-fat dairy & dairy products)|
|Simple Carbs||White breads, pastas, and rice, honey, high fructose corn syrup, agave nectar, maple syrup|
|Phosphorus Additives||Packaged & preserved foods with an ingredient like phosphoric acid (found in ingredients list)|
|Sodium||Prepared/frozen meals, packaged snack foods like crackers, chips, jerky, salted nuts|
|Protein||Animal meats like beef, pork, chicken, and fish|
Now that we’ve gone through things to include and things to limit or avoid in a renal diabetic diet, let’s put it all together!
Below is a renal diabetic diet sample menu. Keep in mind this is just an example – you may have different food preferences and nutritional needs that will be important for your own diet.
Breakfast: Steel cut oats made with almond milk, mixed berries and peanut butter
Snack: Banana “sushi”
Lunch: Veggie and hummus wrap with low-sodium tortilla chips, carrot sticks and guacamole
Snack: Kale chips and nut bar
Dinner: Buddha bowl with brown rice, edamame, cabbage, carrots and green onions topped with tahini miso sauce
Snack: Strawberries, dark chocolate square, and popcorn
Supplements for a Renal Diabetic Diet
Adding supplements into your daily routine is a personal choice and should be based on your personal dietary and health needs. Working closely with your renal dietitian can help identify if supplements, such as probiotics or multivitamins, are good options for you.
Multivitamin vs Renal Multivitamin
Adding a multivitamin to your daily regimen can help you bridge the gap of nutrients that you may be missing in your diet.
You may be able to take a standard daily multivitamin, but as with all medications, it’s important to first discuss with your doctor. Your dietitian will also be able to help determine if you can use a standard multivitamin or if you should instead take a kidney-specific multivitamin.
For patients who need support specific to their renal health, a renal-focused multivitamin may be a better option than a traditional, over-the-counter supplement. This is because it allows you to better control the number of nutrients, such as phosphorus and potassium, you are supplementing to maintain your renal health.
Remember, when selecting a supplement, work with your medical team or registered dietitian to determine which is best for you.
Adding a probiotic supplement to your diet can help improve both your gut health and overall wellbeing. Gut health has been linked to many aspects of health, including insulin sensitivity, and should be a priority for everyone, including those on a renal diabetic diet.
Other potential benefits for including probiotics with CKD include:
- Reduced inflammation
- Reduced oxidative stress
- Less uremic toxins
Some foods also include probiotics. These can be included in a renal diabetic diet, keeping portions in mind.
Many probiotic-rich foods are also high in sodium, potassium, and/or protein. When able, look for low-sodium options and keep portions in moderation.
Watch Jen’s Video About The Renal Diabetic Diet
Navigating a diagnosis of both chronic kidney disease and diabetes may feel overwhelming at first. But finding dietary options to fit your needs doesn’t have to be.
Focus on getting in complex carbs that have fiber to keep blood sugars controlled. Add in some proteins (but not too much), and healthy fats. Potassium may or may not be an issue- that’s something your own doctor or dietitian will talk with you about.
Avoid too many sugars and sugar alternatives, and sodium to prevent problems like uncontrolled blood sugars and blood pressure. Phosphorus additives should be avoided but organic phosphorus is a different story, like potassium.
Working with a renal dietitian can help you create a plan that works best for you, while still allowing you to enjoy foods that you find enjoyable and satisfying.