Best cereal choices for the kidney diet

Today I received a question about the best cereals for a person in stage 3 chronic kidney disease (CKD) to eat. Instead of sending my answer to only one person I thought I would share it with all of you as well.

Some good hot cereal choices include cream of wheat, Malt-o-Meal, grits, and even oatmeal a few times a week. (Stick with the cook and serve cereals instead of the higher sodium instant ones.) Many diet guides place oatmeal in the limit or avoid list because it does contain more phosphorus than the other hot cereals listed.

For ready-to-eat cereals look on the Nutrition Facts label and select the brands lowest in sodium and phosphorus. Lower sodium choices help with blood pressure control. Many cereals give the % Daily Value for phosphorus rather than milligrams. Try to go with those containing 10% DV or less. In general, cereals with added nuts or whole grain tend to have higher amounts of phosphorus.

Our thinking on limiting whole grains is going through a shift currently. You see, in some foods that are naturally high in phosphorus, the phosphorus is bound as phytate and we do not break it down to release all the phosphorus during digestion. So a food naturally high in phosphorus may only contribute 40% to 60% of that phosphorus to the be absorbed into the bloodstream.

Phosphorus containing food additives are 90 to 100% absorbed into the bloodstream. Several ways to lower phosphorus is to avoid foods containing phosphate additives, prepare more meals at home with fresh ingredients, and limit fast foods and processed foods on restaurant menus.  A recent review of chicken products found that many frozen chicken products contain 28%  to 100% more phosphorus than fresh, unenhanced chicken.

The reason for starting to pay attention to phosphorus as early as stage 3 chronic kidney disease is that there are already changes going on in the bones and in kidney regulation of phosphorus and parathyroid hormone (PTH). Research indicates there may be a benefit to keep bones healthier and even slow progression when phosphorus is limited to 800 to 1000 mg/day.

So the next time you go shopping for cereal (or other foods as well), look for the amount of phosphorus on the label. It is not required , so if available the food manufacturer has added it voluntarily. In addition, look at the ingredient list and avoid products that have ‘phos’ food additives.

Kidney diet resources from DaVita.com

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