Carbohydrates and the Kidney Diet

By DaVita Dietitian Christine Swafford, MS, RD, CSR, LD

Carbohydrate, protein and fat are three major nutrients found in foods. Carbohydrates are a major fuel source for your body. They supply energy, which is measured in calories. When you eat carbohydrates, the body turns them into glucose, the energy source for the cells in the body. With insulin, cells are able to use this energy to perform everyday functions, helping you feel your best. Besides providing energy for your body, foods rich in carbohydrates are also good sources of vitamins, minerals, fiber and other compounds that help protect your body.

Carbohydrates, fiber and dialysis

Some carbohydrate foods contain fiber, which plays an important role in protecting your heart, blood vessels and colon. If you have been diagnosed with chronic kidney disease (CKD), you are more susceptible to heart disease, which is the leading cause of death in dialysis patients. High fiber diets help lower cholesterol levels, reducing your risk for heart attack or other cardiovascular conditions. Lowering your cholesterol may even help you stay off certain medications. Some studies show that increased fiber in the diet can reduce blood pressure and inflammation. Many people on dialysis complain of gastrointestinal (GI) symptoms, such as constipation or diarrhea. Fiber can help reduce these symptoms, as well as help control weight and blood sugar levels. Ask your dietitian which high fiber foods may work in your kidney diet.

Carbohydrate foods

Several foods contain carbohydrates, including:

  • Starchy vegetables
  • Breads and grains
  • Beans, peas and lentils
  • Fruits and fruit juices
  • Dairy products, except cheese, butter and cream
  • Sweets and desserts

These foods provide fuel for the body to make energy and affect blood sugar levels if you have diabetes. Meat and fat do not contain carbohydrate, unless a breading or gravy is added. Meat and fat have little effect on your blood sugar levels, but they do contain calories and, similar to excessive carbohydrate intake, will cause weight gain if eaten in large amounts. Talk to your dietitian about which carbohydrate foods are best for the kidney diet.

Carbohydrate serving sizes for the kidney diet

Serving sizes on the kidney diet are important for overall weight control and glucose control if you have diabetes. One serving of a carbohydrate food provides 60-100 calories and 15 grams of carbohydrate. If you are overweight, you may want to decrease the number of servings you consume. If you are underweight, consider increasing the number of carbohydrate servings. If you have diabetes you may follow a plan called carbohydrate counting to help regulate your blood sugar. Consult your dietitian for individual weight or diabetes management plans. Your body requires at least 130 grams of carbohydrate a day to function properly.

A meal usually contains two to four servings of carbohydrate, depending on how many calories you need. A snack may contain one or two servings of carbohydrate. Below are examples of common kidney-friendly carbohydrate foods and the appropriate serving size.

Starches, cereals and grains (Each serving contains approximately 15 grams of carbohydrate)

Food

Serving size

Food

Serving size

Bagel, plain

1 small or 1/2 regular

Cereals, cooked

1/2 cup

White bread (French, Italian, Vienna, sourdough)

1 slice

Cereals, puffed

1 1/2 cups

English muffin

1/2

Cereals, unsweetened

3/4 cup

Hot dog or hamburger bun (white bread)

1/2 (1 ounce)

Cereals, sugar-coated

1/2 cup

Pita bread, plain, 6” across

1/2

Couscous, prepared

1/3 cup

Roll, plain, small

1 (1 ounce)

Granola

1/4 cup

Tabouleh, prepared

1/2 cup

Grits, cooked

1/2 cup

Taco shell, 5” across

2

Pasta, cooked

1/3 cup

Tortilla, flour, 6” across

1

Rice, white, cooked

1/3 cup

Waffle, 4” across

1

Polenta, cooked

1/3 cup

Starchy vegetables (Each serving contains approximately 15 grams of carbohydrate)

Food

Serving size

Food

Serving size

Cassava

1/2 cup

Parsnips

1/2 cup

Corn (higher in phosphorus)

1/2 cup

Green peas (higher in phosphorus)

1/2 cup

Crackers and snacks (Each serving contains approximately 15 grams of carbohydrate)

Food

Serving size

Food

Serving size

Animal crackers

8

Crackers, round-butter type

6

Crackers, saltine-type, unsalted tops

6

Crackers, sandwich-style (cheese, higher in phosphorus)

3

Graham cracker, 2 1/2” square

3

Melba toast, 2”x4”

4 pieces

Oyster crackers

20

Popcorn, unsalted

3 cups

Pretzels, unsalted

3/4 ounce

Rice cakes, 4” across

2

Fruits (Each serving contains approximately 15 grams of carbohydrate)

Food

Serving size

Food

Serving size

Apple

1 medium

Applesauce, unsweetened

1/2 cup

Apricot halves

1/2 cup

Berries (blackberry, blueberry, cranberry, raspberry, strawberry)

1 cup

Cherries

15 large

Fruit cocktail (canned in juice, drained)

1/2 cup

Grapes

15 small

Grapefruit

1/2

Mandarin oranges

1 medium or 1/2 cup

Peach

1 small

Pears

1 small or  1/2 cup

Pineapple

1 medium slice or 3/4 cup

Plums

1 medium or 2 small

Watermelon

1 cup

Fruit juice (apple, grape, cranberry)

1/2 cup (4 ounces)

 

 

Dairy products (Each serving contains approximately 6-12 grams of carbohydrate)

Food

Serving size

Food

Serving size

Milk, skim or fat-free, 1% or 2%*

1/2 cup (4 ounces)

Silk Soy Milk

1/2 cup (4 ounces)

Nondairy creamer

1/2 cup (4 ounces)

Plain Yogurt

1/2 cup (4 ounces)

*Ask your dietitian about high phosphorus and calcium amounts.

Sweets and desserts (Each serving contains approximately 15 grams of carbohydrate)

Food

Serving size

Food

Serving size

Doughnut

1/2 medium

Vanilla wafers

8

Angel food cake, 2” x 2”

1/2 slice

White or yellow cake without icing, 2” x 2”

1 slice

Hard candy

3 pieces

Sherbet

1/4 cup

Fruit juice bars, frozen, 100% juice

1 bar

Fruit spreads

1 1/2 tablespoon

Honey

1 tablespoon

Jam or jelly, regular

1 tablespoon

Gelatin, regular

1/2 cup

Sugar

1 tablespoon

Diabetes and carbohydrates

If you have diabetes, understanding which foods contain carbohydrates and how much you can eat is important for blood sugar control. Blood sugar levels should run between 80-120 mg/dL before eating, and below 180 mg/dL two hours after eating. Taking diabetes medication prescribed by your doctor is not enough to manage blood sugar levels. Controlling diabetes includes:

  • Following a healthy diet (as instructed by your dietitian)
  • Eating at consistent meal and snack times and not skipping meals
  • Following recommended serving sizes and reading food labels
  • Balancing carbohydrate intake throughout the day
  • Checking blood sugar levels often

Carbohydrate foods to avoid or eat only occasionally

Not all carbohydrates fit into a kidney diet because they contain high amounts of phosphorus, potassium, sodium or fluid, such as:

Avocados

Bananas

Beans (baked, kidney, lima, pinto or soy)

Biscuits

Bran, granola or whole wheat cereal

Buttermilk

Candy bars, with chocolate and/or nuts

Cantaloupe

Chocolate milk

Cookies, pre-packaged (unless recommended by a dietitian)

Cornmeal mix

Cream soups

Dried fruits

Frosted or sugar-coated cereals

Ginger bread

Gravy

Honeydew

Ice cream

Instant cereals

Instant pudding

Kiwi

Mangos

Oatmeal

Oranges/orange juice

Pancake mix

Peas and lentils

Pies and cakes, pre-packaged

Potato chips, corn chips, salted crackers

Potatoes

Pumpkin

Rutabagas

Sauerkraut

Star fruit

Succotash

Whole grain bread

Winter squash

Carbohydrates and hemodialysis

If you do in-center hemodialysis or home hemodialysis (HHD), you may have different carbohydrate needs for your dialysis diet. Your individual need for foods containing carbohydrate is typically half of your diet or more. This means 50-60% of your total daily calorie intake should come from carbohydrate foods. For example, if you need 2,000 calories to meet your daily needs, then 1,000-1,200 calories should come from carbohydrate foods. This equals 250-275 grams of carbohydrate a day.

Carbohydrates and peritoneal dialysis

For people on peritoneal dialysis (PD), the need for carbohydrates is less than for people on hemodialysis. In PD, a dialysate containing dextrose — a form of sugar — is used to pull waste and fluid out of the blood. Because dextrose is a carbohydrate like glucose, your body absorbs these calories, decreasing your need to consume carbohydrates in food. These excess calories can affect weight control and blood sugar management. This means only 35-40% of your total daily calories should come from carbohydrate foods while on PD, because 15% of your calorie needs will be absorbed from the dialysate. The rest of your calories should come from protein foods and fat. For example, if you need 2,000 calories per day, 700-800 calories should come from carbohydrate foods. This equals 175-200 grams of carbohydrate a day. Approximately 300 calories are provided from the dialysate throughout the day.

The percentage of dextrose in your dialysate and the type of PD you choose — continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) — may affect how many calories your body absorbs. This table shows how many calories you may absorb per liter:

Dextrose amount

CAPD calories absorbed

APD calories absorbed

1.5%

31-36 calories/liter

20-26 calories/liter

2.5%

51-60 calories/liter

34-43 calories/liter

4.25%

87-102 calories/liter

58-73 calories/liter

Consider which type of dextrose you use for treatment and how many bags you use each day. You may gain weight if you use too much of the more concentrated solution. Your dietitian and health care team can assist you in maintaining weight and blood sugar control and optimizing the appropriate treatment for you.

Summary

Carbohydrates are important when you’re on the kidney diet. Carbohydrate foods can give you the energy you need to go about your daily activities. Whether you have early stage kidney disease, are on a particular type of dialysis treatment or have diabetes will determine how many carbohydrates you should have per day. Work with your dietitian on deciding which carbohydrates are best for your kidney diet.

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