What should a diabetic with kidney disease eat for breakfast

Food for Thought

How much thought do we give in preparing our breakfast each day?

A waft of that crisp, hearty bacon smell. Soft creamy eggs cooked to perfection. Milk with cereal to deliver happiness on a plate. Breakfast sure is an important meal of the day for many of us.
More often than not, however, we have no time to plan our meals. From morning traffic stories we move to early trips to school. From work commitments, we move to endless errands. Here, we fail to be conscious of our breakfast routines. We don’t always think that the food we eat is healthy enough.

While nutritional value comes as a second thought to most, this is not the case for individuals with chronic kidney disease (CKD), since being aware of what you eat is essential. In this article, we will focus on common American breakfast foods and determine which of them are great for a kidney-friendly breakfast. 

Why should you follow a kidney-friendly diet?

Statistics indicate that in the United States, about 15% of adults experience chronic kidney disease. This affects life at all stages. Health problems leading to lower quality of life, if not addressed, can lead to renal failure -- and even death.

While procedures like dialysis and kidney transplant exist for kidney disease, these can become economically, physiologically and mentally burdensome. Thus, a proper diet coupled with a sustainable healthy lifestyle are effective measures to protect your kidneys from further damage.  

A kidney-friendly breakfast is a great start towards managing your CKD condition.

The Typical American Breakfast

The typical American-style breakfast consists of a main dish: Eggs. These are cooked in various ways: scrambled (omelet), poached, or fried with the yolk side up. Eggs are typically paired with meats such as bacon or sausages. Choices for the side are either muffins, waffles, bagels, pancakes, or toast. Drinks served include either coffee, tea, water, milk, or juice. Sometimes, lighter options such as oatmeal and cereals serve as quick, easy-to-prepare substitutes. The common vegetable is a side of potatoes, usually fried or baked.

Eggs

An egg is a staple in many dishes across many cultures. Most times our groceries would include eggs, as an ingredient for dessert or as a main dish. A Single medium-sized egg contains about 78 calories, of which 6.5 grams is pure protein. Fat in eggs is considered healthy, since most half of it is unsaturated fat. Unsaturated fat helps in balancing cholesterol levels. It also reduces the risk of heart disease. Learn more here.

Other viable nutrients found in eggs include:

• Vitamin A
• Folate
• Choline
• Phosphorus
• Selenium
• Vitamin D
• Vitamin B12
• Riboflavin

The Verdict

A study on diet and physical activity of adults conducted by Trichopoulou et al. (2006), points to higher intakes of eggs being related to diabetic mortality. However, no evidence has been provided to support this. Eggs are, therefore, safe for CKD patients. Nevertheless, you should eat them in moderation. 

Meat: Bacon and Sausages

A 2020 study published in the Journal of Renal Nutrition examined the risk of chronic kidney disease of 4881 individuals using the protein diet. According to the study, kidney function decline is seen in diets containing animal meat (processed and unprocessed red meat) as compared to other sources (legumes, nuts, grains). This was explained by dietary acid load that is seen with meat consumption.

Acid load reduces the kidneys’ capacity to filter protein sources properly. Thus, CKD patients need to regulate the amount of potassium, sodium, protein and phosphorus in their food.

Processed foods contain preservatives that help prolong shelf-life as well as enhance flavor. However, they also contain excess amounts of sodium and phosphorus which are not suitable for CKD individuals. The Dietary Guidelines for Americans indicate a maximum of 2,300 mg sodium intake daily.

For renal disease patients, this reference is only 1,500 mg. Bacon and sausages are usually cured using salt. One ounce of bacon contains about 400 mg of sodium, which already takes up a fifth of the recommended number. A three-ounce sausage contains sodium ranging from 500 mg to 1500 mg.

The Verdict

Since processed meats such as sausage and bacon are loaded with sodium and phosphate, they are not recommended for people with CKD. If your nephrologist suggests you monitor your protein consumption, it is important to limit or steer clear from processed meats. 

Carbohydrates

Carbohydrates are the basic third of the food we eat. It provides energy to start our day. In the case of American breakfast choices, it is understandable that bread is not exactly on the list of potential foods to avoid. However, bread is named as the top food item contributing to sodium intake in the regular diet. 

Research from around the world has studied salt components of breads. It has been determined that the typical wheat bread has 400mg sodium content. This is about 26% of the 1500 recommended daily amounts for CKD suffering individuals. The American breakfast contains many types of bread. Thus, it is important to choose the right kind for CKD. Several breads contain some amounts of saturated fatty acids, sugar, and cholesterol. Those types include wheat bread and sweet and savory, which you should avoid. You can check which types of bread you can consume in our blog post.

The Verdict

Bread is okay for people with CKD but you must opt for low sodium and low sugar options such as white bread and bagel. Read the nutrition label and serving portions when shopping.

Cereal and Oatmeal

Cereals and oatmeal are typically found in an American table as they are convenient and easy-to-prepare. However, the National Kidney Foundation (NKF) says that most cereal brands today contain hidden salt, phosphorus, and potassium. These nutrients can elevate your phosphorus and potassium levels that can endanger your kidneys. 

Picking the right cereal and oatmeal products can also make the difference. Make sure to avoid cereal containing dried fruits, nuts, and chocolate since they are loaded with sugar. Added sugar can be harmful for diabetic people with CKD. Check the sweetener content when shopping for cereals. Sweeteners have different names like fructose, sucrose, maltose, or brown rice/corn syrup. Be wary of the serving size. If the box says a serving of  ¾ cup of cereal contains 5 g of sugar, but you consume 1 ½ cup, this means your total sugar consumption in one meal is 10g.

Oatmeal is preferable to cereal. It is  fiber-rich and has less sugar. In the case of  breakfast food items to pick, Bagels, Muffin bread, Rolls, certain brands of cereal and Oatmeal are recommended. On the other hand, items made from bran and whole wheat are foods to avoid-- especially for those with elevated potassium levels. Sweet products like pancakes and waffles are included. 

The Verdict

Cereals and oatmeal are, generally, not recommended for CKD patients since they are rich in sugar, added phosphate and potassium. However, you can find low sugar and sodium alternatives. You can read our blog to learn more about cereals for CKD. 

Fluids

People who go through dialysis are often told to limit their fluid intake to prevent dialysis machines from extracting too little or too much fluid from the bloodstream. You can help your kidneys by watching your fluid intake, even though you are most likely not on dialysis yet. 

American breakfast ideals include milk, juice, and coffee for drinks. Consider the following:

Milk

Milk is a versatile drink that can be consumed alone or mixed with cereals or smoothies. Although it is a popular drink for many, people with (CKD) have to limit their dairy intake, including milk in their renal diet. As kidney function declines, it becomes harder to remove the excess minerals such as potassium and phosphorus found in milk. You can consume dairy milk alternatives such as oat, almond, and soy to manage the phosphorus and potassium levels in your body.  Most renal dietitians encourage CKD patients to restrict their cow’s milk intake due to its high phosphorus and potassium content.

Juice

Most juicing recipes are loaded with potassium and sugar content. Fruits and vegetable juices are more concentrated in natural sugar than natural fruits and vegetables. If you have blood sugar issues, you must watch your fruit and vegetable juices consumption. Canned vegetable juices are typically loaded with sodium. It is best to discuss juicing with your healthcare provider if you have declining kidney functions.

Coffee

Coffee is an acceptable beverage for people with CKD. It comes with a caveat though. You need to watch the additives and amount of coffee you drink daily to monitor your potassium and sugar consumption. Drinking more than 3 cups of coffee and adding creamers could jack up your potassium levels. 

The Verdict

Coffee is a reasonable beverage for CKD patients while drinking juices and milk comes with a warning. Be wary of vegetable and fruit juices since they can be loaded with phosphate and sodium. You can go for dairy-free milk alternatives such as plant-based milk to manage your phosphorus and sodium intake. 

Fruits and Vegetables

Vegetables and fruits are the primary sources of potassium in the human diet. Ideally, fruits and vegetables are good for the body because they are rich in fiber, anti-oxidants and micronutrients. However, some are not good for those who need a kidney-friendly diet since they are loaded with nutrients that can spike up your sodium, phosphorus, potassium and protein in your blood system. 

Potassium-rich vegetables to avoid typically include:

• Artichoke 
• Baked potato 
• Bamboo shoots, fresh 
• Beet greens 
• Bok choy 
• Brussel sprouts 
• Chinese cabbage 
• Dried beans 

• Dried peas

• Lentils 
• Mushrooms (cooked)
• Spinach (cooked)
• Split peas 
• Sweet potato 
• Tomato
• Winter squash (pumpkin)
• Yucca

Potassium-rich fruits to avoid typically include:

• Apricots
• Avocado
• Bananas/plantains
• Cantaloupe
• Coconut
• Dates/figs/dried fruits
• Grapefruit/grapefruit juice
• Guava
• Honeydew melon 

• Kiwi Mango 

• Nectarines 
• Oranges/orange juice 
• Papaya 
• Pomegranate/pomegranate juice
• Prunes/prune juice 
• Starfruit 
• Tamarind

Tips to keep in mind

Now, we know that a typical American breakfast can have foods that are both friendly and bad for people who have CKD. Food items that are recommended for the renal diet include:

• Eggs
• Bread
• Juice, milk, water, some drinks
• Fruits and vegetables

On the flip side, it is best to steer clear from processed meats and food products rich in certain nutrients such as potassium, sodium, and phosphorus.

Other tips to keep in mind when choosing the best American breakfast diet include the following:

Eggs

A tip that usually comes up is to take out the yolks and eat only the whites, to limit the amount of potassium. Studies have not been conducted to test this ”tip.” So far, however, the health benefits of removing the yolk highly outweigh the risks.

Bacon & Sausages

It is best to consider locally sourced, unprocessed products. These are healthier alternatives. Another great tip is to read the nutrient content on product labels. That way, you  can avoid going over the recommended values for sodium and phosphorus.

Carbohydrates

High amounts of sodium in bread flavor processing require strict monitoring. These should be limited in the kidney-friendly diet. Choose bread that is made from refined flour instead of whole wheat. Phosphorus and potassium contents are higher for whole-grain types. However, it is best to consult a renal dietitian before adding it into your diet.

Cereals and Oatmeal

For cereals and oatmeal, check product labels and package descriptions to make sure of nutrient contents of your chosen food product. Oatmeal is preferable over cereals. Still, as long as you can monitor your sugar intake, you are good to go.

Fluids, Fats, and Oils

The best advice is to choose foods, which contain unsaturated fats. They have been proven to give many health benefits. Unsaturated fats are easier to break down because of their molecular structure. These are found in plant-based protein. In contrast, saturated fats are especially present in meat products.

Fruits and Vegetables

A tip to ensure lower potassium intake is to avoid potassium-rich foods. You can boil them in water for this. This tip is useful because potatoes and tomatoes comprise the typical American breakfast.

One Before you go…

Take this piece of advice to help you: Start off your day by starting it right.

A proper diet is the best way to combat Chronic Kidney Disease (CKD). To support a proper diet, having a daily meal plan will work wonders. But as always, you can consult with a medical professional for your (most recommended) options. This helps to ensure that your health is well-monitored. 

Sources:

A prospective study of dietary meat intake and risk of incident chronic kidney disease; E. Yuzbashian, Ph.D.; F. Azizi, MD; G. Asghari, Ph.D.; M. Aghayan, MD; M. Mahdavi, MD; P. Mirmiran, Ph.D. -
https://doi.org/10.1053/j.jrn.2019.06.008

Common Foods That Are High in Sodium; S. Lehman, MS -
https://www.verywellfit.com/watching-your-sodium-intake-2505914#:~:text=Sausage&text=Sausages%2C%20as%20well%20as%20most,oftentimes%20more%20than%201%2C500%20milligrams.

Diet and chronic kidney disease; H. Kramer, MD, MPH -
https://doi.org/10.1093/advances/nmz011

Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort; A. Trichopoulou, MD, Ph.D.; T. Psaltopoulou, MD; P. Orfanos, Ph.D.; D. Trichopoulos, -

https://doi.org/10.1111/j.1365-2796.2006.01638.x

Dietary reference intakes for sodium and potassium; National Academies of Sciences, Engineering, and Medicine -
https://doi.org/10.17226/25353

Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort; A. Trichopoulou, MD, Ph.D.; T. Psaltopoulou, MD; P. Orfanos, Ph.D.; D. Trichopoulos, -

https://doi.org/10.1001/jama.294.19.2455

Get the facts: Sodium and the dietary guidelines; Centers for Disease Control and Prevention -

https://www.cdc.gov/salt/pdfs/sodium_dietary_guidelines.pdf

Renal Diet; New York-Presbyterian Hospital Department of Food and Nutrition -

https://www.nyp.org/documents/nutrition/resources/RenalDietEnglish.pdf

Researchers analyzed the salt in 2,000 types of bread in 32 countries. Here's what they found. How much salt is in bread? J. Belluz, MSc -

https://www.vox.com/science-and-health/2018/4/12/17226478/salt-bread-sodium-analysis

Sodium: How to tame your salt habit -
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/sodium/art-20045479