DASH Diet For Kidney Disease: Does it Work? (Part 2 of 2)

Should you tweak the popular DASH diet if you have kidney disease

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(This is the concluding part 2 of this article. Click here for part 1


Meandering through well-meaning guidelines put out by national organizations can be a daunting task when the average person with kidney disease (and high blood pressure, and perhaps diabetes) sits down looking for tips on healthy eating. Things can get confusing pretty quickly!

Here are some examples:


One important aspect that these guidelines fail to emphasize is that we are not treating disease conditions (like diabetes, hypertension, or kidney disease) in isolation.

We are treating the patient as a whole, and quite often patients will concurrently have all or some of these chronic diseases. Therefore, from a perspective of the typical kidney disease patient here are some pointers that could be of help:

  1. For most patients with early kidney disease (stages 1 to 3 CKD), the typical DASH diet should still work well.
  1. All guidelines seem to agree about restricting sugar and sodium intake. In fact, for kidney disease, you might want to restrict daily sodium intake to 1500 mg. Click here for in-depth information.
  2. What really creates the major conflict between the above guidelines is NIH/DASH and CDC not customizing dietary recommendations for nutrients with significantly altered metabolism in patients with kidney disease. These would be primarily potassium, phosphorus, and even fluids. These are of the greatest concern to people with late kidney disease (stages 4 and 5)
  3. High potassium levels are common in patients with advanced kidney disease; hence if you are at risk or have had high potassium reported (hyperkalemia), you might need to restrict whole wheat, brown rice, bran cereal, etc
  4. High phosphorus levels again are common in advanced kidney disease and can set off a cascade of metabolic derangements that can lead to bone disease (also called CKD related mineral and bone disorder) with high risk of fractures. Hence if your nephrologist finds that you have this problem, you may need to restrict meat, whole grain, nuts, and dairy (especially those sources which have a high ratio of absorbable phosphorus).
  1. DASH does not say anything about fluid intake. You obviously need to drink enough to prevent dehydration, but in advanced kidney disease too much fluid intake can lead to fluid accumulation in the skin, in the lungs, and can put strain on the heart. Have your nephrologist make you some specific recommendations. 
  2. Protein intake might need to be optimized in kidney disease. Here are the details

As you might be able to appreciate, the DASH diet plan is an evidence based dietary recommendation that works well for most people, at risk for kidney disease or otherwise. However, it might need slight modification based on your disease profile and risk factors. Coming up with a plan that works for you, and is not a one-size-fits-all will require coordination between you, your nephrologist, and your dietitian. 

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