Milk Alternatives for People with Chronic Kidney Disease

By DaVita® Dietitian Chien-Wei Kung, RD

“got milk?®” This phrase --- developed by the California Milk Processor Board --- has become one of the most recognized slogans in advertising history. The popular campaign for increasing consumption of dairy started in the 1990s and has featured numerous celebrities and cultural icons crediting milk for their strong bones and muscle health.

Yet people with chronic kidney disease (CKD) have to limit dairy product intake in their kidney diet. Eight ounces of low-fat milk contains 8 grams of protein, 230 mg of phosphorus, 366 mg of potassium and 290 mg of calcium. The high levels of these minerals are not good for someone trying to adhere to a kidney diet.

People with CKD are urged by their dietitian to limit consumption of dairy products, usually to half a cup of milk, half a cup of yogurt or one ounce of cheese per day. People considering low-fat milk as a better option may be surprised to learn that it is actually less kidney-friendly than the high-fat counterparts, because low-fat milk contains higher levels of potassium and phosphorus.

But isn’t milk good for my bones?

Bones are mostly made of calcium and phosphorus. When kidneys function well, they are able to keep these two minerals in balance in the blood and bones. However, kidney disease causes this process to become dysfunctional:

  • Excess phosphorus cannot be excreted by the kidneys and builds up in the blood
  • Kidneys no longer activate Vitamin D which affects the ability to absorb calcium from food eaten
  • Low blood calcium levels cause calcium (and phosphorus) to be released from the bones, weakening them over time
  • Increased phosphorus in the blood combines with calcium, causing calcifications elsewhere in the body and decreasing amount of blood calcium
  • More calcium (and phosphorus) is released from the bones and a vicious cycle is initiated

Despite milk’s calcium content, its high phosphorus content may actually weaken bones.

There is calcium in both hemodialysis and peritoneal dialysis (PD) solutions, so patients receive some of their daily calcium requirements with their dialysis treatments. In addition, some phosphate binders also contain calcium. Therefore, it is unusual for a dialysis patient to get insufficient amounts of calcium.

Are there any alternatives to milk if I have kidney disease?

Yes. In recent years, the number of alternative milk choices in the market has grown significantly. Soy milk and nondairy creamer can be found in most grocery stores, while products such as rice milk and almond milk have also gained in popularity. However, some of these products do contain significant amounts of potassium and/or phosphorus. It is important to check the label for additives containing these nutrients.

What should I consider in choosing a milk alternative?

Calcium, phosphorus, potassium and protein content should all be considered when choosing a milk alternative. Your dietitian can help you determine which milk alternative is right for your diet. Unfortunately, only calcium and protein are usually listed on food labels. The amount of phosphorus and potassium in the product are not often included in the nutrition facts. However, DaVita has developed the Food Analyzer, a database that details nutrients in many foods you eat, including potassium and phosphorus. The ingredient list often gives clues to help when selecting a milk alternative. Products with phosphate additives or fortified with calcium would not be the best choices.

It is also important to be aware that product formulas can change. One brand of soy milk that is low in phosphorus may be fortified with phosphorus the following year. Even within the same brands, different flavors can have varied amounts of phosphorus, calcium and potassium. It often helps to contact the company directly to get the most current nutritional information. Here are some milk alternatives that people with kidney disease may consider using in their diets:

Rice milk

  • Rice Dream® Rice Drink Original Classic
  • Rice Dream Rice Drink Vanilla Classic

Nondairy creamer

  • Nestle® Coffee-Mate®, Original Fat Free
  • Nestle CoffeeMate Original Low Fat
  • Nestle CoffeMate Original
  • Rich’s® Coffee Rich®, Regular and Fat Free
  • Mocha Mix® Original

Soy milk

  • Edensoy® Light Vanilla Soy Milk
  • Edensoy Light Original Soy Milk
  • PacificTM Select Soy Low Fat Plain
  • Pacific Select Soy  Low Fat Vanilla

Almond milk

  • Almond Breeze®, Unsweetened Original
  • Almond Breeze, Unsweetened Vanilla
  • Pacific Organic Almond Unsweetened Low Fat Original
  • Pacific Organic Almond Unsweetened Low Fat Vanilla
  • Pacific Organic Almond Original
  • Pacific Organic Almond Vanilla

What types of meals can I make with my milk alternatives?

Many recipes call for milk as a key ingredient. DaVita.com has a wealth of recipes that can help a person make kidney-friendly meals with alternative milk products. Here are some yummy choices:

Breakfast

Lunch

Dinner

Dessert

Beverages

Summary

Although regular milk contains high amounts of phosphorus, potassium and calcium, that doesn’t mean people with kidney disease can’t enjoy the various substitutes for it. Milk alternatives, such as rice milk, nondairy creamer, soy milk and others, are available so that people who have health issues don’t have to give up milk altogether.


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