By Carra Moroni, LDN, RD

Diabetes and chronic kidney disease (CKD) are two serious illnesses. Each of these  diseases can be hard to deal with and very frustrating. Having both may be even harder but is actually very common. More than half of people with CKD are diabetic. In fact, according to the American Diabetes Association, diabetes is the leading cause of CKD.

Nutrition and proper diet play a major role in diabetes and in CKD. Each has its own set of nutrition rules which are important to know when it comes to planning a healthy diet. Menu planning may seem hard when one has both diabetes and CKD, but hopefully the following information will show just how easy it really is.

First, let’s review a few diabetic diet rules. Carbohydrates are the main focus when it comes to the diabetic diet. Carbohydrates, which are broken down to sugar when eaten, are found in many different types of foods such as starches, fruits, milk products, puddings, candies, cakes and other sweets. It is important to eat the same amount of carbohydrate-containing foods at each meal. An eating routine is also an important part of the diabetic diet. This means no skipping meals and eating around the same time every day. Eating the same amount of carbohydrates at each meal and having an eating routine are very helpful in keeping blood sugars under control.

Another good idea is to practice portion control. As part of a healthy diet, it is important not to overeat. Finally, as a diabetic, you have a higher risk for heart disease. This means you should choose low fat and low sodium foods.

Carbohydrate Counting

This is a diabetic meal planning system based on counting the servings of carbohydrates in each meal or snack consumed. This system is helpful in keeping your blood sugars at good levels. Fifteen grams of carbohydrates is equal to one carbohydrate serving, 30 grams equals two carbohydrate servings, and 45 grams equals three servings. The foods in the charts on the following page each equal one carbohydrate serving or 15 grams of carbohydrates. Remember to eat the same number of carbohydrate servings at each meal. The number of servings that should be eaten is different for everyone depending on one’s calorie requirements; however, three servings at each meal is a good starting point.

Once proper portion sizes are learned, diabetics can easily use carbohydrate counting on a daily basis. Now, for those who have diabetes and CKD, there are a few more diet rules to remember. As someone with CKD, one has to limit sodium, potassium and phosphorus consumed. These nutrients are found in many carbohydrate-containing foods. This means these foods should not be eaten at all or should be eaten on a very limited basis. The following charts list carbohydrate-containing foods that are low in sodium, potassium and phosphorus, as well as the proper serving sizes.
 

The above charts list proper serving sizes of carbohydrate containing foods that are low in potassium, phosphorus and sodium. As mentioned before, three carbohydrate servings at each meal is a good starting point. One should talk to a registered dietitian to determine personal caloric needs and to determine if more or less carbohydrate servings are needed at each meal. Although variety in diet is very healthy, the combination of foods eaten from the above list does not have to be particular. One could choose to have three servings of fruit at breakfast as long as no other carbohydrate foods are eaten at that meal. If one were to have a hamburger at lunch, each half of the bun would count as one serving (the whole bun would count as two servings). This is fine but remember only one other starch, fruit or milk product can be eaten at that meal.

Diets do not consist of carbohydrates alone, so let’s talk about non-carbohydrate foods that are good to eat. Meats are a healthy part of one’s diet. Meats provide protein and minerals. Keep in mind though that meat is also high in phosphorus.

Meats and High-Protein Foods Okay to Eat
Poultry
Fish
Seafood (not boiled in high sodium seasonings)
Lean cuts of meat
Eggs
Low cholesterol egg substitute
Cottage cheese (limit because of high sodium
content)

Beverages Okay to Drink
Water
Crystal Light®
Diet sodas that are clear (Diet Sprite®, diet ginger ale)
Unsweetened tea or lemonade made at  home         
(*Remember to limit the amount of fluids if you are on a
fluid restriction)

Diet Barq’s Root Beer®
Vegetables low in potassium and phosphorus are a healthy addition to one’s diet. Vegetables are low in calories and high in vitamins and minerals.

Vegetables Okay to Eat
Asparagus
Cabbage
Carrots
Beets
Cauliflower
Eggplant
Frozen broccoli cuts
Iceberg lettuce
Kale
Celery
Green and red peppers
Cucumbers
Onions
Snow peas
Summer squash
Turnips
Radishes

All of the previous are foods that are okay to eat. However, there are many foods (both carbohydrate containing and carbohydrate-free foods) that should be avoided or limited. Remember this is only if you are on both a diabetic and renal diet. A few examples are listed below.

Milk Products to Avoid
Chocolate milk
Buttermilk
Sweetened yogurt
Sugar-sweetened ice cream, puddings and frozen desserts

Starches to Avoid
Whole wheat or whole grain breads
Whole grain cereals (bran flakes, granola, oatmeal, etc.)
Sugar-coated and instant cereals
Gingerbread, pancake, biscuit and cornbread mixes
Potato chips, corn chips and salted crackers

Meat and High-Protein Foods to Avoid
High-sodium meats including bacon, hotdogs, sausages, canned and luncheon meats, organ meats, pepperoni, salami
Cheeses (American, cheddar and Swiss)
Nuts
Peanut butter
Dried beans (pinto, kidney, lima, lentil or soy)

Fruits and Vegetables to Avoid
Cantaloupe
Avocados
Bananas
Dates, raisins and prunes
Fresh pears, honeydew melon, star fruit, mangos, kiwi and papaya
Nectarines, oranges and orange juice
Pomegranate
Kumquats
Artichoke
Fresh broccoli
Okra
Spinach
Tomatoes, tomato sauce or paste, tomato juice
Vegetable juice
Brussels sprouts
Baked potatoes, sweet potatoes and yams
Winter squash and pumpkin

Other Foods That Should be Limited
Regular sugar
Syrup (maple and chocolate)
Honey and molasses
Chocolate
Candy (candy bars, jelly beans, gum drops, hard candy)
Pies and cakes
Cookies
Donuts
BBQ sauce and ketchup
High-sodium marinades, soy sauce and
Worcestershire sauce
Table salt, garlic salt and onion salt
TV dinners
Canned foods
Pizza
Salty snacks
Meat tenderizer
Dark colas such as Coke®, Pepsi® and
Dr.Pepper® (diet and regular)
Beer
Hawaiian Punch®, Sunny Delight®, Gatorade®,
Powerade®
Canned or sweetened tea and lemonade

There are many foods that should be avoided in the diabetic renal diet, but there are also many foods to be enjoyed. A healthy diet will be easy to follow after learning to count carbohydrates and learning which foods should be avoided. Following a healthy diet helps control blood sugar, potassium, sodium and phosphorus levels. Keeping these things under control is important for your overall health and wellbeing. Be healthy. Start following a good diabetic renal diet today.

Carra Moroni, LDN, RD, is a clinical/outpatient dietitian at Touro Infirmary in New Orleans. 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 health care provider for appropriate care.

This article originally appeared in the June/July 2006 issue of Kidney Beginnings: The Magazine, Vol. 5, No. 2.