Lunches On-The-Go for the Dialysis Diet

Written by DaVita dietitian, Sara Colman, RD, CSR, CDE

Sitting down at the kitchen table for a home-prepared lunch is rare these days. Work, school, errands, working out and other activities cut into our days, leaving less time for meals prepared at home. Living with chronic kidney disease (CKD) involves additional time commitments due to lab tests, hospital procedures and appointments. People on dialysis also spend extra time going to dialysis treatments. The challenge of balancing all you do and fitting in a healthy lunch is still possible. Even if you don’t have a chance to sit down for a relaxing, home-cooked lunch, you can have a healthy, on-the-go one with a little planning.

Planning a lunch solution

Take a few minutes to think about your schedule and make a plan to fit in healthy, renal-friendly lunches. You can plan sack lunches, leftovers, frozen meals, fast foods, nutrition bars or nutrition drinks. If you plan ahead, you’ll have the items on hand to pack your on-the-go lunch. Knowing about your dialysis or kidney-friendly pre-dialysis diet is the first step in planning your lunch on-the-go options. By following the guidelines provided by your dietitian and the tips in this article, lunch will be easy and will fit into your dialysis or kidney-friendly pre-dialysis diet.

What can I eat?

Do you have a meal plan? This is a guideline that provides lists of foods included on your pre-dialysis or dialysis diet. It tells how many servings of different foods you need in a day to provide the calories, protein and nutrients you need. Ask your dietitian for an individualized meal plan with a food guide, if you do not have one. Also ask for additional meal planning resources such as menus, grocery shopping guides and eating out suggestions.

Once you know the foods that are healthiest for you to eat, you can alternate among sack lunches, leftovers, fast foods, frozen meals and nutrition bars and drinks to create the most appealing and easy lunches.

Sack lunches

Packing a lunch is the best way to keep sodium, potassium and phosphorus in control — because you control what goes into the sack. There are many exciting sandwich or salad combinations to choose from.  Here are a few tips for putting together super sack lunches:

  • Fresh is always best. If possible, make meat sandwiches from low-sodium, fresh-cooked meats such as chicken, turkey breast, roast beef, pork or fish.  Use meat leftover from dinner, or cook fresh meat specifically for lunch sandwiches. Consider freezing cooked meat in 2 to 3 ounce portions until needed.
  • Egg salad or fried egg sandwiches are good low-sodium, high-protein choices.
  • When selecting canned tuna or chicken, pick the no-salt-added brands or rinse salted products for 3 minutes to reduce sodium content.
  • Limit deli meats. These are convenient and provide protein, but sodium content is around 300 milligrams per ounce. Stick with turkey, chicken or ham.  Highly processed meats like bologna or salami contain more sodium and phosphorus additives. Try to reduce sodium at other meals on the days you eat deli meats for lunch.
  • Make sandwiches and pack your sack lunch the evening before. If you make it a habit, you will always be ready with a lunch to go. Prepare it before or after your dinner or breakfast meal if possible.
  • Freeze bread and meat sandwiches in individual sandwich-size freezer bags. Before leaving home, pack it up with a separate container of desired toppings, such as mustard, mayonnaise, lettuce, oil, vinegar, cucumbers, bell pepper strips, onion, a tomato slice, pepper or herb seasoning.
  • Remember to pack your phosphorus binders.

There are many ways to add variety to your sandwiches.

For breads, choose one of these:  bagels, cracked wheat, dinner rolls (white), flour tortillas, French bread, hamburger buns, Italian bread, light rye, pita bread, rice cakes, sourdough or white bread.            

For spreads, choose one or more of these:  cranberry sauce, cream cheese, flavored mustard, horseradish, hot sauce, jam, jelly, ketchup (limit to one tablespoon), mayonnaise, salad dressing (low sodium), sour cream or yellow mustard.

For toppings, choose one or two of these:  alfalfa sprouts, basil leaves, bean sprouts, bell peppers, cilantro, cucumber, lettuce, low-sodium pickle, onions, roasted red peppers, tomato slice (1) or water chestnuts.                       

For additional flavor, choose one or two of these:  black pepper, curry powder, flavored oil, Mrs. Dash® Herb Seasoning, olive oil, red pepper flakes, sweet pickle relish, vinegar, Worcestershire sauce.      

To complete your sack lunch, choose from the following:

  • fresh apple, plum, peach, grapes, pineapple or strawberries
  • snack-sized container of applesauce, fruit cocktail, pears, peaches or pineapple chunks
  • Unsalted pretzels, popcorn, tortilla chips
  • Animal crackers, graham crackers, oyster crackers, melba toast, unsalted saltines or other low-sodium crackers
  • Vanilla, lemon or spice cookies, cupcake or cake

Leftovers

Leftovers from meals the day before may be the answer to a quick lunch. Plan to prepare extra portions, and package foods in containers that can go from freezer or refrigerator to microwave. Reheat leftover casserole or stew or a combination of meat, rice and vegetables. If a microwave is unavailable, pack leftovers that can be enjoyed cold, like chicken breast or leg, slices of turkey or roast beef, lamb chops, hardboiled or deviled eggs, coleslaw, pasta, or tossed salad.

Remember to include fruit or dessert — homemade cookies, muffins, cake or other leftover goodies. Invest in an insulated lunch tote. Pack an ice pack or a frozen bottle of water to keep food cold. You may discover that packing leftovers decreases food waste, saves lunch money and gives you an opportunity to enjoy healthier home-prepared foods.

For great meal ideas that can make good leftover lunches, check the Recipe Section of DaVita.com. There are over 350 kidney-friendly recipes with more added every week. All recipes were submitted by DaVita dietitians for those with chronic kidney disease who are pre-dialysis, dialysis or diabetic dialysis.

Fast Foods

Fast food restaurants are another option for lunch on the go, if you learn to choose wisely. Make kidney-friendly adjustments to the foods you order. Extra sodium, phosphorus and potassium are often hidden in fast foods. Identify your favorite best choices from the fast food places you visit. Make this your usual list to help avoid ordering specials or tempting items that are not part of your diet.

Burger fast food places

  • Hamburger on a bun with lettuce, onion, mayonnaise, mustard or

1 packet ketchup; no cheese or special sauce

  • Grilled or broiled chicken sandwich with mustard or mayonnaise, lettuce, onion; no cheese, no breading
  • Side salad, limit the dressing
  • If you must, onion rings instead of French fries—limit the ketchup and the portion size
  • Order the smallest size beverage with extra ice and take small sips

Chicken or fish take-out

  • Go for grilled or roasted without the high-sodium breading (or remove breading)
  • Best sides include: coleslaw, pasta salad, white roll, green beans, 1/2 ear corn on the cob
  • Avoid the potatoes and biscuit to keep potassium and phosphorus lower

Mexican fast food

  • Beef, chicken, pork or shrimp fajita
  • Beef, chicken or fish taco on flour tortilla; no cheese
  • Chicken or beef burrito with rice, sour cream, a little salsa or hot sauce (leave off the beans and cheese)
  • Chicken or beef taquitos with sour cream instead of guacamole
  • Rice instead of beans
  • Limit salsa or hot sauce to 1 tablespoon or 1 packet

Sub sandwich shop

  • Stick to the 6” sub on a white roll
  • Turkey, chicken, roast beef, ham and egg salad are better choices
  • Good toppings include:  lettuce, onion, cucumber, thin slice of tomato, bell pepper, vinegar, oil, pepper, mayonnaise, small amount of mustard
  • Omit the cheese to keep phosphorus and sodium down
  • Omit sauces, olives and pickles to lower sodium
  • For sides, try a small salad, low-salt tortilla chips or cookie without nuts or chocolate
  • Order the smallest beverage — lots of ice, no refills, no cola

Chinese take-out

  • Stir-fry shrimp, chicken, pork or beef with lower potassium veggies such as bell peppers, cabbage, carrots, eggplant, green beans, mushrooms, onions and water chestnuts
  • Egg rolls or fried wontons or small salad with vinegar-based dressing for appetizers
  • Skip the salty soups to save on fluid and sodium
  • Request no MSG and ask for sauces on the side
  • Use limited amount of low-sodium soy sauce, if it must be added
  • Order steamed white rice instead of fried rice which contains soy sauce

Frozen meals

TV dinners are traditionally known for having high-sodium content. Today many frozen food manufacturers cater to health-conscious consumers concerned about fat, sodium and good nutrition. Many of the reduced sodium, healthy cuisine frozen meals are acceptable for a dialysis diet.  

Healthy Choice®, Lean Cuisine® and Weight Watchers® are some brands that have entrées low enough in sodium for a dialysis diet. Here are some guidelines to follow when making your selections. As always, check with your renal dietitian for additional guidance.

  • Look for meals with less than 700 milligrams sodium.
  • Choose frozen meals that provide a meat, poultry or fish entrée, rice or noodles, vegetable and dessert, if desired.
  • Avoid meals with high-phosphorus ingredients such as beans, cheese and cheese sauces.
  • Most frozen meals contain 1/2 cup or less of vegetables. Best choices are green beans, broccoli, carrots, cauliflower, peppers and small amounts of corn and peas. To keep potassium lower, avoid those with tomato and potato products.

Most frozen meals heat in the microwave in 3 to 7 minutes. Less time may be required if your meal has started to thaw. Pack a fork and napkin in preparation for your frozen lunch on the go.

Nutrition bars and drinks

Sometimes it’s easier to grab a protein bar or nutrition drink when eating on the run. Protein bars provide more nutrition than quick-grab foods like candy bars, chips, cookies or donuts. Thanks to the recent high-protein/low-carbohydrate trend, market shelves are stocked with high-protein energy bars — many that are acceptable for a pre-dialysis or dialysis diet. A few things to be aware of when selecting a protein bar to fit your needs:

  • Calories vary from 110 to 300 calories. Bars marketed to women are often lower in calories. A higher-calorie bar is better if using the bar as a meal replacement.
  • Protein ranges from 10 to 24 grams per bar — that’s equal to 1-1/2 to 3 ounces of meat.
  • Carbohydrates range from 13 to 50 grams per bar. For people with diabetes, remember each 15 grams of carbohydrate count as one carbohydrate serving.
  • Sodium usually ranges from 100 to 280 mg per bar.  Lower sodium is better. Even at the higher end, this is much less sodium than found in fast food items.
  • Phosphorus can range from 100 to 350 mg phosphorus per bar (10% to 35% of the Daily Value). Lower amounts are best — and phosphorus binders should be taken when eating a protein bar.
  • Calcium can range from 100 to 500 mg per bar. Extra calcium is often undesirable for people on dialysis. Lower amounts are best for those trying to reduce calcium intake.
  • Average cost of most bars is around $2.00, close to the price of a sandwich or burger. Look for sales, coupons and volume-pricing specials to save a few bucks.

Many nutrition drinks are available at local grocery or drug stores. Types vary from low-calorie diet meal replacements (such as Slim-Fast®), high-protein drinks marketed to body builders and medical-nutrition drinks for health improvement. Like protein bars, these supplements vary in calories, protein, sodium, potassium, phosphorus and calcium content. Special nutrition drinks formulated for kidney patients usually have reduced amounts of sodium, potassium and phosphorus compared to drinks developed for people on a regular diet plan.

Some of the drinks often recommended by renal dietitians include Nepro®, Re/Gen®, Re/Gen sugarfree®, Nutrarenal® and Novasource Renal®. Special diabetic formulas, such as Boost Diabetic® and Glucerna® are lower in carbohydrates, but may have high levels of potassium and phosphorus compared to renal formulas. Often, medical nutrition supplements are recommended during periods when patients aren’t eating enough nutrients, but they can also be an option for a quick meal replacement. Check with your dietitian for advice on the best bar or nutrition drink for you, if this is your choice for a lunch on the go.

What about drinks?

Remember to consider the beverages you drink. If you are on limited fluids, be sure to divide your daily allowance between meals, snacks and medication times. Select the smallest container or one with a screw-top lid to help keep the amount of fluids you drink in check.

Beverages lower in sodium, potassium and phosphorus are the best choices for people with kidney disease and those on dialysis. Read the ingredient label and nutrition facts on all canned, bottled and packaged beverages. Avoid drinks containing phosphorus or calcium additives. More often phosphate additives and extra calcium are showing up in drinks that were previously phosphorus and calcium free, so make sure to check nutrient content and ingredient lists.

Choose from these beverages that are acceptable for a kidney diet:

  • Juices:  apple, cranberry, grape, pineapple, peach nectar, raspberry or strawberry
  • Sodas (regular or diet):  7-Up®, Sprite®, ginger ale, lemon-lime, root beer, club, cream, grape, orange or strawberry
  • Other beverages:  Kool-Aid®, Capri-Sun®, punch, homemade lemonade or limeade, tea, herbal tea, coffee, water, sparkling water or fruit-flavored water

Food safety

Remember food safety when carrying on-the-go meals. Germs and bugs can grow in food when temperatures are not cool enough. Use an insulated bag with an ice pack or bottle of frozen water to keep foods cold. Wash your hands with soap and water or use a hand sanitizer before eating. Enjoy your lunch.


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