VRG > Vegetarian Journal > 2009 Issue 4 > Menu Selection for Vegan Renal Patients

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Healthy Tips and Recipes for Institutions from The Vegetarian Resource Group

Menu Selection for Vegan Renal Patients

By Chef Nancy Berkoff, RD, EdD

A proper renal diet is extremely important for patients with chronic kidney failure. Many health care professionals have shown that a carefully planned vegetarian diet is adequate in managing chronic kidney failure.

It is vital that a renal patient's food and fluid intake be overseen by a nephrologist and a registered dietitian familiar with vegan diets. These professionals can help manage kidney disease with appropriate vegan food and fluid choices. The information in this article is not designed to replace consultation with medical doctors and registered dietitians. This article provides general guidelines and information about vegan diets that can be used in menu planning for people with chronic kidney disease, stage 2 or 3, in conjunction with consultation with health care professionals who treat people with kidney disease.

In kidney disease, nutrition management focuses on decreasing waste products built up from digested foods. The goals for planning a vegan renal diet, as for any other renal diet, are to:

• Obtain the appropriate amount of protein to meet protein needs while minimizing waste products in the blood
• Maintain sodium, potassium, and phosphorus balance
• Avoid excessive fluid intake to prevent overload
• Ensure adequate nutrition

The information provided in this article is meant as a very general guideline for patients that have at least 40-50 percent normal kidney function (chronic kidney disease, stage 2 or 3) and who are not currently receiving dialysis. For patients with lower kidney function or who are receiving dialysis, very individual diet planning must be done. All renal patients need to be closely monitored, with regular blood and urine testing.

Vegan Protein

Renal patients need to limit the amount of protein in their daily diets. For this reason, the protein in the diet needs to be high-quality protein. Very generally, depending on individual ability and needs, 0.8 gram of protein per kilogram of body weight is recommended per day. This translates to approximately 2 ounces of pure protein per day for a 140-pound person.

High-quality vegan protein for renal patients includes tofu, peanut butter (no more than two Tablespoons

per day), tempeh, and beans. Soy meats, such as textured vegetable protein (TVP) or vegan ground round, are high in quality protein but are also high in sodium, phosphorous, and potassium, which need to be limited.

Soy protein has been found to assist in minimizing some complications from kidney disease. Patients should have at least one serving of soy a day, such as soymilk, tofu, or tempeh. Again, it is a balancing act for renal menus - a small amount of soy each day may be beneficial, but too much can be harmful.

Here are some tips for including soy products on your vegan renal menu:

• Mash a few Tablespoons of regular tofu with croutons and seasonings to 'extend' the tofu and decrease the amount of protein served.
• Add small chunks of regular tofu-rather than animal protein-to soups, stews, and stir-fries.
• Use silken tofu instead of vegan mayonnaise in salad dressings, sandwich fillings, and sauces.
• Crumble up regular tofu, add a spicy seasoning (without salt), and quickly sauté to top rice or pasta, or use as a filling for a taco or burrito or to top a pizza crust.

Beans and nuts are good sources of high-quality protein. However, they can be high in phosphorus and potassium, so the amounts served need to be carefully calculated. Try to use dried beans or beans frozen without salt. Canned beans, even lower sodium beans, are usually high in sodium.

A way to balance potassium intake is to include needed protein (which may be high in potassium) and then to select fruits and vegetables that are lower in potassium.

Sodium

Some vegetarian foods can be very high in sodium. Here are suggestions for avoiding excess sodium on the menu:

• Avoid using ready-to-eat foods, such as frozen meals, canned soup, dried soups, or packaged vegetable broths.
• Use miso very sparingly.
• Use lower-sodium soy sauces very sparingly, as there is still a lot of sodium in these soy sauces.
• Limit soy- and rice-based cheeses.
• Amino acid preparations, such as Bragg's Liquid Aminos, can be very concentrated in protein, potassium, and phosphorus; if the patient wants to include these types of products, they will need to be calculated into the daily intake.
• Read the labels for vegan meats (such foods as tofu hot dogs and veggie burgers) or other canned or frozen soy products.
• Read the labels for seasoning mixtures to avoid excess sodium.

Potassium

Potassium may not need to be strictly restricted unless the function of the kidney decreases to less than 20 percent. Routine blood testing is the best way to know a patient's potassium requirements. Approximately two-thirds of dietary potassium comes from fruits, vegetables, and juices. The easiest way to limit potassium would be to limit fruit and vegetable selections based on the level of potassium in the patient's blood.

A common limitation is five servings of fruits and vegetables per day. A potassium serving size is generally:

• 1/2 cup fresh fruit, canned fruit, or juice
• 1 cup fresh vegetables
• ½ cup cooked vegetables

If a patient would like several servings of protein, alternative protein selections may be needed to keep potassium levels from going too high. This will mean using more tofu and seitan, rather than beans or textured vegetable protein (TVP), at every meal. Blackstrap molasses, spinach, Swiss chard, beet greens, and prunes are very high in potassium and may need to be limited or avoided.

Phosphorus

Depending on the extent of an individua's kidney disease, phosphorus may need to be restricted. Foods high in phosphorus include bran cereals, wheat germ, whole grains, dried beans and peas, colas, beer, cocoa, and chocolate drinks. For more information about high phosphorus foods, see www.kidney.org/atoz/ atozitem.cfm?id=101. Dried beans and peas and whole grains are high in phosphorus, but because of their high phytate content, they may not cause phosphorus in the blood to be elevated as much as would be expected. Individual monitoring by the health care provider is necessary to determine the appropriate level of dietary phosphorus.

Adequate Nutrition

A vegan diet can be lower in calories and higher in fiber than an animal-based diet. This is great news for healthy patients. However, for vegan renal patients, we need to ensure that there is no weight loss or loss in nutritional status. Here are some tips for adding more calories to a vegan renal diet:

• Make shakes with soymilk, tofu, rice milk, and non-dairy frozen dessert. Some patients, especially those with very limited kidney function, may need to use unfortified soymilk or rice milk and unfortified soy yogurt.
• Use more oils, such as olive oil in cooking. Drizzle flaxseed oil on food after it is cooked, or mix with salad dressing and serve over lettuce.
• Provide frequent small meals if patients feel full very quickly.
• Even though sugar is not the best selection in a diet, for a renal patient who needs extra calories, sorbet, vegan hard candy, and jellies may be added.

Additional Ideas When Planning Vegan Renal Menus

• Avoid using salt or salt substitutes. Use herb mixtures, such as Mrs. Dash, or mixtures you create yourself with fresh or dried herbs.
• If you need to use canned broths, purchase the lowest-sodium version possible.
• Use fresh or frozen (without salt) fruits or vegetables when possible.
• Lower potassium fruits and veggies include wax beans, green beans, kiwi, watermelon, onions, head lettuce and Romaine lettuce, bell peppers, pears, and raspberries.
• Lower phosphorus foods include sorbet, unsalted popcorn, white bread and white rice, hot and cold rice cereals, pasta, cold corn-based cereal (such as Corn Flakes and Corn Chex), Cream of Wheat hot cereal, and grits.

Icy Smoothie

(Serves 4)

• 2 cups soft silken tofu
• 3 cups ice
• 2 Tablespoons coffee powder or green tea powder
• 2 teaspoons vanilla extract
• 2 Tablespoons rice syrup

Place all ingredients in a blender and process until smooth and thick. Serve immediately.

Total calories per serving: 109	Fat: 3 grams
Carbohydrates: 13 grams	Protein: 6 grams
Sodium: 24 milligrams	Fiber: <1 gram
Potassium: 255 milligrams	Phosphorus: 75 mg

Hot Spiced Cereal

(Makes approximately 1 quart or four 1-cup servings)

• 4 cups water
• 2 cups cream of rice or other hot rice
• cereal, grits, or Cream of Wheat
• 1 teaspoon vanilla extract
• ¼ cup maple syrup
• 1 teaspoon powdered ginger

Bring water to a boil in a medium pot. Whisk in cereal and lower heat. Continue to stir until mixture is smooth. Reduce to a simmer. Stir in remaining ingredients. Allow to cook, stirring, until desired texture is attained.

Total calories per serving: 376	Fat: <1 gram
Carbohydrates: 85 grams	Protein: 5 grams
Sodium: 7 milligrams	Fiber: <1 gram
Potassium: 166 milligrams	Phosphorus: 108 mg

Lemon Hummus

(Makes approximately 1 pint)

This spread is higher in phosphorus and potassium than other spreads, but it is a good source of protein.

• 2 cups cooked garbanzo beans
• 1/3 cup tahini
• ¼ cup lemon juice
• 2 minced garlic cloves
• 1 Tablespoon olive oil
• ½ teaspoon paprika
• 1 teaspoon parsley flakes

Place garbanzo beans, tahini, lemon juice, and garlic in a blender or food processor. Blend until smooth. Transfer mixture to a serving bowl. Drizzle olive oil over the mixture. Sprinkle with paprika and parsley. Serve with pita triangles or unsalted crackers.

Total calories per serving: 72	Fat: 4 grams
Carbohydrates: 7 grams	Protein: 3 grams
Sodium: 4 milligrams	Fiber: 2 grams
Potassium: 88 milligrams	Phosphorus: 75 mg

Corn and Cilantro Salsa

(Serves 6-8)

This is an unusual twist on the usual salsa recipe.

• 3 cups fresh white or yellow corn cut from the cob
• ½ cup chopped cilantro
• 1 cup chopped sweet onions (such as Vidalia or Maui)
• ½ cup chopped fresh tomato
• 4 Tablespoons lemon or lime juice
• ¼ teaspoon dried oregano
• 2 teaspoons chili powder or red pepper flakes

Place corn in a medium-sized bowl. Add remaining ingredients and mix well. Cover and refrigerate for at least one hour prior to serving.

Total calories per serving: 89	Fat: 1 gram
Carbohydrates: 21 grams	Protein: 3 grams
Sodium: 9 milligrams	Fiber: 3 grams
Potassium: 270 milligrams	Phosphorus: 72 mg

Mushroom Pockets

(Serves 6)

Here's a tasty vegetarian version of soft tacos.

• 2 Tablespoons water
• 2 Tablespoons lemon or lime juice
• 1 Tablespoon vegetable oil
• 2 minced garlic cloves
• 1 teaspoon ground cumin
• 1 teaspoon crushed dried oregano
• 3 cups thinly sliced fresh mushrooms, such as portobello caps, white button, or brown crimini
• 1 cup thinly sliced bell pepper
• ½ cup chopped scallions (white parts only)
• 3 Tablespoons shredded vegan soy cheese
• Six 7-inch flour tortillas

In a large bowl, mix water, juice, oil, garlic, cumin, and oregano. Add mushrooms, peppers, and scallions. Stir to coat. Allow to marinate for at least 30 minutes. If desired, this can be done the day before.

Heat a large saut&3acute; pan. Sauté vegetable mixture with marinade until the peppers and scallions are soft, approximately 5-7 minutes. Allow to continue cooking until most of the liquid has evaporated.

While veggies are cooking, wrap tortillas in a paper towel and heat in a microwave, or wrap in foil and heat in a 350-degree oven.

Place each tortilla on a plate. Spoon on vegetable mixture and top with cheese.

Total calories per serving: 147	Fat: 5 grams
Carbohydrates: 23 grams	Protein: 4 grams
Sodium: 262 milligrams	Fiber: 1 gram
Potassium: 267 milligrams	Phosphorus: 64 mg

Fruit Cobbler

(Serves 8)

• 3 Tablespoons melted nonhydrogenated vegan margarine
• 1 cup all-purpose unbleached flour
• ¼ teaspoon salt
• 1 teaspoon baking powder
• ½ cup rice milk
• 3½ cups pitted fresh cherries*
• 1¾ cups white vegan sugar, divided
• 1 Tablespoon cornstarch
• 1 cup boiling water

Preheat oven to 350 degrees.

In a medium-sized bowl, combine margarine, flour, salt, baking powder, and rice milk and mix just to combine.

In a separate bowl, toss cherries with ¾ cup sugar and place cherries in the bottom of an 8-inch square pan. Place dough in small pieces over cherries to cover cherries in an even pattern.

In a small bowl, combine remaining sugar and cornstarch. Whisk in boiling water. Pour cornstarch mixture over the dough. Bake for 35-45 minutes or until bubbly. Serve warm or cold.

Note: You can use thawed frozen pitted cherries; peeled and cored fresh pears; or fresh or thawed frozen raspberries to replace a part of or all of the fresh cherries.

Total calories per serving: 315	Fat: 5 grams
Carbohydrates: 68 grams	Protein: 2 grams
Sodium: 170 milligrams	Fiber: 2 grams
Potassium: 159 milligrams	Phosphorus: 87 mg

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Nancy Berkoff is The Vegetarian Resource Group's Food Service Advisor. She is the author of Vegan in Volume.