By Stacey Adams, MPH, RD, CDN

Fast food has become a way of life for many people because of busy schedules and many responsibilities. These days, there are many different restaurants to choose. Being on dialysis should not prevent you from making those reservations. Eating out can actually be healthy, and you can do so while still complying with your renal diet. Your diet should consist of protein, carbohydrates and fat. Protein in the form of chicken, turkey, eggs, beef and fish, is used by the body to build and repair tissues, provide energy and plays a role in other bodily processes. Carbohydrates, such as bread, cereal, grains, fruits and veggies, are the body’s main sources of energy. Fats are used by the body for energy as well. When kidney function deteriorates, it becomes necessary to restrict certain foods in the diet because of the body’s inability to rid accumulated waste products and fluid.

As a result, you will need to limit your intake of phosphorus, potassium, sodium and fluid. The degree of restriction will vary from patient to patient. Factors usually considered are state of health, other diseases present, such as diabetes. Also considered are lab values, food preferences and age. Your dietitian will help you figure out what will work best for you.

The daily dietary breakdown for a hemodialysis patient is approximately:

• 1800-2000 calories
• 1.2 g/kg of protein
• 50-60 percent of calories from carbohydrates
• 1-3 grams of sodium
• 2-3 grams of potassium
• 800-1200 mg phosphorus
• 4 cups fluid (depends on several factors, i.e. doctor’s order, urine production, etc.)
• 60-100 mg Vitamin C

Remember, these are just estimates and will vary with each person. Eating out within these guidelines is possible and should not be avoided out of fear of not knowing what to choose.

Here are some Ideas for eating out a little healthier:

Italian Food

• Ask for the sauce on the side or for dishes to be served without tomato sauce.
• Try pesto sauce, which is made with garlic, basil and oil.
• Be careful of cream sauces, which contain high phosphorus.
• Choose salads and breads with dressing on the side.
• Avoid olives and cheeses.

Asian Food

• For Chinese restaurants, try egg rolls, dim sum and stir-fry vegetable dishes without sauce. Ask for food to be cooked with ginger for added flavor. Food should be cooked without MSG and extra soy sauce should be avoided. Ask for low sodium soy sauce that you can add yourself. Choose steamed rice instead of fried to avoid sodium.
• For Thai restaurants, try beef, chicken or kebob dishes with sauce on the side, spring rolls, steamed rice, grilled fish and chicken dishes with the sauce on the side.
• For Japanese restaurants, try sashimi and sushi (no California rolls with avocado), tempura and grilled fish or chicken with sauce on the side. Ask for dishes to be steamed and have low sodium soy sauce on the side so you can control the amount.

Mexican

• Choose salsa made with chili peppers instead of tomatoes.
• Avoid guacamole because it is made from high potassium avocados.
• Limit beans and potatoes.
• Choose enchiladas, fajitas or burritos.
• Ask for sauces on the side.
• Beware of mango, papaya and guava, as these fruits contain a lot of potassium.

Fast Food

• Ask for the salt to be left off.
• Choose a small non-cola soda rather than milk or a shake. Also remember your fluid restriction.
• Burgers may be high in sodium because they are pre-salted. Be sure and ask.
• Try the rice as your side. Avoid baked potatoes and French fries, which are high in potassium.
• Ketchup, mustard and pickles are high in sodium. Request these items on the side so that you can control the amount used.
• Choose broiled, steamed or grilled items instead of fried foods. Remove skin before eating to help reduce fat and sodium, because coatings on the skin are usually high in sodium.
• Visit the salad bar. Fruits and vegetables provide many necessary vitamins and minerals. Choose items, such as lettuce, radishes, cauliflower, celery, onions, cucumbers, beets, alfalfa sprouts, green peppers, zucchini and low-calorie dressing. Avoid items, such as avocado, bacon, chickpeas, kidney beans, nuts, olives, raisins, pickles, relish, nuts, seeds, cheese and tomatoes.

General Advice

• Ask for a breakdown of the fat, calories and other nutritional information (potassium, phosphorus and sodium).
• Remember to take your binders with you.
• Beware of dishes prepared with milk and nuts as they contain much phosphorus.
• Pay attention to your fluid intake.
• Follow your diet very carefully the rest of the day.
• Avoid the salt. It will elevate your blood pressure and increase your thirst, which could lead to excessive fluid intake.
• Avoid smoked or cured meats as they are very salty.
• Fresh garlic, garlic powder, onion powder, paprika, pepper, lemon and vinegar and oil are okay.
• Do not be afraid to ask for your food to be prepared in a certain way, because they will often accommodate you.
• Fruit ice, Jell-O or sherbet make for great dessert choices.
• Portion control is key, so consider sharing your dish or asking for a “doggie bag.”

BON APETIT! ENJOY!

Stacey Adams, MPH, RD, CDN, is a renal dietitian at the Rogosin Institute in New York City, where she has worked for nearly four years. She has been a Registered Dietitian for six years, during which she earned her Master’s Degree in Public Health Nutrition.

The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care.

This article originally appeared in the March 2005 issue of aakpRENALIFE, Vol. 20, No. 5.

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