Medical Nutrition Therapy for Renal Disease

DIETARY MANAGEMENT WITH THE RENAL CHOICE SYSTEM

This system is used in the calculation of the Renal Diet. Foods are divided into groups according to nutrient content and
contain roughly equivalent protein, sodium, potassium, and phosphorus content. To differentiate the renal system from the
exchange system used for diabetes, the decision was made to use the word choice rather than exchange when referring to
specific foods. Choices have been defined in household measures. For food service portioning, they may be further defined
by utensils, or multiples or fractions of the standard portion. The lists here are intended to be a reference for initial planning
of diets and menu writing. Additional foods and recipes can be translated into choices through evaluation of micronutrient
content.

The following information and Renal and Renal Diabetic Choice Lists are reprinted with permission from The
American Dietetic Association, “National Renal Diet: Professional Guide,” “Healthy Food Guide for Hemodialysis,” and
“Healthy Food Guide for Diabetes and Hemodialysis,” 1993.

Choice Protein CHO Sodium Potassium Phosphorus Energy

List (g) (g) (mg/mEq) (mg/mEq) (mg/mEq) (kcal)

Milk 4 12 (8)a 80/3 185/5 110/7 120 (100) a

Nondairy 0.5 12 40/2 80/2 30/2 140

Meat 7 — 25/1 100/2 65/4 65

Vegetables 1 5 15/0 0-350/0-9 20/1 25

Starches 2 18 (15) a 80/5 35/1 35/2 90 (80) a

Fruits 0.5 17 (15) a 0 0-350/0-9 15/1 70 (60) a

Fats 0 — 55/3 10/.25 5/0 45

High Calorie 0 25 (15) a 15/0 20/.5 5/0 100 (60) a

Salt Choices — — 250/11 — — —

a
Values represent diabetic renal exchanges that differ from renal exchanges. CHO indicates carbohydrate.
Food Choice Lists
The food choice lists are presented in a logical sequence of meal planning beginning with Milk and Meat choices, because
the quantity and quality of protein are top priorities in renal diets. Moreover, these high-quality protein foods contain large
amounts of phosphorus, and phosphorus restriction is a major goal for all renal patients regardless of treatment modality.
The following descriptions of the food groups provide rationales for the inclusion or exclusion of certain foods and explain
how serving sizes were established.

Milk choices: Due to the large amount of phosphorus and potassium in milk and milk products, portion sizes are 0.5 cup
or equivalent to 4 g of protein. Milk products that are high in refined carbohydrate are excluded from the diabetes renal
lists; consequently, the average kilocalorie value is lower in those lists.

Nondairy Milk Substitute choices: These nondairy items are much lower in phosphorus, potassium, and protein than are
regular dairy products. Therefore, they can be used easily in renal diets to substitute for milk and to provide sufficient
energy.

Meat choices: Each serving on this list is equal to about 7 g of protein, 4 g of fat, and 65 kcal. Meat choices that contain
250 mg or more of sodium are footnoted to indicate that they are also a Salt choice.

Starch choices: This group contains all breads, cereals, pastas, crackers, and selected desserts. Dried beans and legumes
do not appear on this list because they contain large quantities of potassium, phosphorus, and nonessential amino acids. In
addition, bran and whole-grain items are significantly limited because of their high phosphorus content. With these
modifications, the average protein content of the starch group is 2 g per serving.

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Average Potassium Values of Vegetable and Fruit Choices

Average (mg) per Range (mg)

Serving

Low potassium 70 1-100

Medium potassium 150 101-200

High potassium 270 201-300

Very high potassium — 301-350

Vegetable choices: The average protein content of this group is 1 g. The portion size is 0.5 cup, and the vegetables on the
list are divided into low-, medium-, and high-potassium groups.

Fruit choices: To facilitate accurate calculation of low-protein diets, 0.5 g of protein is assigned to the fruit group. For
dialysis diets, in which protein intake is not as closely controlled, the dietitian should decide whether to use this value in
calculating the meal plan. Fruits are divided by potassium level for dialysis diets as just described. The kilocalorie level
assigned to fruits for the diabetes renal lists is lower because sweetened fruits are excluded from the lists.

Fat choices: Seeds and nuts are omitted from this list because they contain low-quality protein, phosphorus, and
potassium.

High-Calorie choices: This list includes refined carbohydrates and low-protein products, which provide energy without
adding protein. These foods can be used to meet high-calorie needs without exceeding optimal levels of protein and
electrolytes, or as concentrated sources of energy for patients with poor appetites. High-Calorie choices contain
approximately 100 kcal in the nondiabetes renal lists and 60 kcal (15 g of carbohydrates) in the diabetes renal lists.

Salt choices: The calculation figures are presented with assumption that salt is not added in the preparation of food. Some
patients require a specific amount of sodium, which cannot be provided unless their meal plans include some salt or salt-
containing foods. Salt choices, equal to 250 mg of sodium per serving, can be calculated into the diet to arrive at the
optimal sodium level for each patient.

Beverage choices: For patients undergoing hemodialysis and for some patients undergoing peritoneal dialysis, fluid intake
must be restricted. Because some beverages contain large amounts of potassium, phosphorus, or both, the amounts allowed
should be calculated into the daily meal plan.

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DETERMINING THE DIET PRESCRIPTION

Before determining a patient’s diet prescription and calculating his or her meal plan, a complete nutrition assessment
should be performed, with special attention to the following factors:

1. Medical history.
2. Physician’s orders.
3. Treatment modality (pre-end-stage renal disease [ESRD], hemodialysis, or peritoneal dialysis). Nutrition
management of the renal patient depends on the method of treatment as well as on medical and nutritional status.
A comparison of treatment methods and primary concerns in each is summarized in the table below.
4. Presence of other chronic diseases, which may affect the nutritional status. As a result, the diet prescription also
will be affected.

Comparison of Treatments and Major Concerns for Pre-ESRD, Hemodialysis, and Peritoneal Dialysis Patientsa

Pre-ESRD Hemodialysis CAPD or CCPD

Treatment Diet and medications Diet and medications; Diet and medications;
Hemodialysis peritoneal dialysis

Modality None Dialysis using vascular Dialysis using peritoneal

access for waste product membrane for waste
and fluid removal product and fluid removal

Duration Indefinite 3-5 hr 3-5 exchanges

2-3 days/wk 7 days/wk

Concerns Glomerular hyperfiltration; Amino acid loss; Protein loss into dialysate;
rise in BUN; bone disease interdialytic electrolyte and glucose absorption from
fluid changes dialysate

Hypertension; glycemic Bone disease; hypertension Bone disease; weight gain;

control in diabetes hyperlipidemia; glycemic
control in diabetes
a
CAPD indicates continuous ambulatory peritoneal dialysis; CCPD, continuous cyclic peritoneal dialysis; and BUN, blood (serum) urea nitrogen.

PROCEDURE FOR CALCULATING RENAL DIETS

1. Establish the diet prescription (nutrient goals) based on the general recommendations for renal patients (from
The American Dietetic Association’s “National Renal Diet: Professional Guide”, 1993 and the nutrition
assessment.
2. Obtain a recall of the patient’s usual eating patterns.
3. Determine the amount of HBV protein to be provided. At least two-thirds of total protein intake should be from
high-quality protein.
4. Using the calculation figures, determine the number of Milk and Meat choices needed to meet the HBV protein
requirement.
5. Divide the remaining protein allowance among Fruit, Vegetable, Starch, and Nondairy Milk Substitute choices.
6. Provide for the remainder of the energy requirements with Fat and High-Calorie choices.
7. Total each nutrient and adjust the diet to meet the previously established nutrient goals.
8. Add Salt choices, if necessary to meet the diet prescription for sodium. (This may be calculated into a regular
salted item.)
9. Incorporate Beverage choices based on individual preferences and diet parameters.
10. Formulate a meal plan based, as much as possible, on the patient’s usual intake and preferences.
11. Provide a sample menu based on the food choices and the patient’s usual eating pattern.

Note: Because of other, more important parameters of the diet, percentages of energy contributed by carbohydrates
and fats may differ from those recommended for people with diabetes and good kidney function.

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HEALTHY FOOD GUIDE FOR KIDNEY DISEASE

MILK CHOICES
1 choice = 4 g protein 1 choice = 0.5 g protein
= 120 kcal = 140 kcal
= 80 mg sodium = 40 mg sodium
= 185 mg potassium = 80 mg potassium
= 110 mg phosphorus = 30 mg phosphorus
Milk Choices Amount Nondairy Milk Substitutes Amount
Milk (nonfat, low-fat, whole) ½ cup Dessert, nondairy frozen ½ cup
Lo Pro 1 cup Dessert topping, nondairy frozen ½ cup
Buttermilk, cultured ½ cup Liquid nondairy creamer,
Chocolate milk ½ cup polyunsaturated ½ cup
Light cream or half-and-half ½ cup
Ice milk or ice cream ½ cup
Yogurt, plain or fruited-flavored ½ cup
Evaporated milk ¼ cup
Sweetened condensed milk ¼ cup
Cream cheese 3 tbsp
Sour cream 4 tbsp
Sherbet 1 cup
MEAT CHOICES
1 choice = 7 g protein
= 65 kcal
= 25 mg sodium
= 100 mg potassium
= 65 mg phosphorus
Prepared without added salt Prepared with added salt
Meat Amount Meat Amount
Beef 1 oz Beef 1 oz
Round, sirloin, flank, cubed, Deli-style roast beefb
T-bone and porterhouse steak; Pork 1 oz
Tenderloin, rib, chuck, and rump Boiled or deli-style hamb
Roast; ground beef or ground chuck Poultry 1 oz
Pork 1 oz Deli-style chicken or turkeyb
Fresh ham; tenderloin; Fish
Chops; loin roast; cutlets Canned tuna, canned salmonb 1 oz
Lamb 1 oz Sardinesa,b 1 oz
Chops; leg; roasts Cheese
Veal 1 oz Cottageb ¼ cup
Chops; roasts; cutlets
Poultry 1 oz
Chicken; turkey; Cornish
Hen; domestic duck and goose Meat/Protein Sources to Avoid:
Fish
• Bacon
Fresh and frozen fish 1 oz
Lobster; scallops; shrimp; clams 1 oz • Black beans, black-eyed peas, great northern beans,
Crab; oysters 1½ oz lentils, lima beans, navy beans, pinto beans, red
Canned tuna; canned salmon 1 oz kidney beans, soybeans, split peas, turtle beans
(canned without salt) • Frankfurters; bratwurst; Polish sausage
Sardines (canned without salt)a 1 oz • Luncheon meats, including bologna, braunschweiger,
Wild game 1 oz liverwurst, picnic loaf, summer sausage, and salami
Venison; rabbit; squirrel; • Nuts and nut butters
Pheasant; duck; goose • All cheeses except cottage cheese
Egg
Whole 1 large
Egg white or yolk 2 large a
bHigh
phosphorus.
Low-cholesterol egg product ¼ cup High sodium — each serving counts as 1 Meat choice and
Chitterlings 2 oz 1 Salt choice.
Organ meats a 1 oz

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STARCH CHOICES
1 choice = 2 g protein
= 90 kcal
= 80 mg sodium
= 35 mg potassium
= 35 mg phosphorus

Breads and Rolls Amount Cereals and Grains Amount

Prepared without added salt
Bread (French, Italian, raisin, 1 slice (1 oz) Cereals, ready-to-eat, most brands a ¾ cup
Light rye, sourdough, white) Puffed rice 1½ cup
Bagel ½ small Puffed wheat 1 cup
Bun, hamburger or hot dog type ½ Cereals, cooked
Danish pastry or sweet roll, no nuts ½ small Cream of Rice or Wheat, ½ cup
Dinner roll or hard roll 1 small Farina, Malt-O-Meal
Doughnut 1 small Oat bran or oatmeal, Ralston 1/3 cup
English muffin ½ Cornmeal, cooked ¾ cup
Muffin, no nuts, bran, or whole wheat 1 small (1 oz) Grits, cooked ½ cup
Pancake a,b 1 small (1 oz) Flour, all-purpose 2½ tbsp
Pita or “pocket” bread ½ 6-inch diameter Pasta (noodles, macaroni,
Tortilla, corn 2 6-inch diameter spaghetti), cooked ½ cup
Tortilla, flour 1 6-inch diameter Pasta made with egg (egg noodles),
Waffle a,b 1 small (1 oz) cooked 1/3 cup
Rice, white or brown, cooked ½ cup
Crackers and Snacks Desserts
Crackers: saltines, round butter 4 crackers Cake, angel food 1 oz
Graham crackers 3 squares Cake 2  2-in square or
Melba toast 3 oblong 1½ oz
RyKrisp a 3 crackers Sandwich cookie a,b 4 cookies
Popcorn, plain 1½ cup popped Shortbread cookie 4 cookies
Tortilla chips ¾ oz, 9 chips Sugar cookie 4 cookies
Pretzels, sticks or rings a ¾ oz 10 sticks Sugar wafer 4 cookies
Pretzels, sticks or rings, unsalted ¾ oz, 10 sticks Vanilla wafer 10 cookies
Sweetened gelatin ½ cup
Fruit pie 1/8 pie
Starches to Avoid

• Bran cereal or muffins; Grape-Nuts cereal; granola

cereal or bars
• Boxed, frozen, or canned meals; entrees; or side dishes
• Black beans, black-eyed peas, great northern beans,
lentils, lima beans, navy beans, pinto beans, red kidney
beans, soybeans, split peas, turtle beans a
High sodium — each serving counts as 1 Starch choice
• Pumpernickel, dark rye, whole wheat, or oatmeal bread and 1 Salt choice.
• Whole wheat cereals b
High phosphorus.
• Whole wheat crackers

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 Medical Nutrition Therapy for Renal Disease

VEGETABLE CHOICES
1 choice = 1 g protein
= 25 kcal
= 15 mg sodium
= 20 mg phosphorus

Prepared or canned without added salt

unless otherwise indicated

Vegetables Amount Vegetables Amount

Low Potassium (0-100 mg) High potassium (201-350 mg)
Alfalfa sprouts 1 cup Asparagusa 5 spears
Bamboo shoots, canned ½ cup Avocado ¼ whole
Beans, green or wax ½ cup Beets ½ cup
Bean sprouts ½ cup Brussels sproutsa ½ cup
Cabbage, raw½ cup Celery, cooked ½ cup
Chinese cabbage, raw ½ cup Kohlrabi ½ cup
Chard, raw ½ cup Mushrooms, fresh cookeda ½ cup
Cucumber, peeled ½ cup Okraa ½ cup
Endive ½ cup Parsnipsa ½ cup
Escarole ½ cup Pepper, chili ½ cup
Lettuce, all varieties 1 cup Potato, boiled or mashed ½ cup
Pepper, green, sweet ½ cup Pumpkin ½ cup
Water chestnuts, canned ½ cup Rutabagasa ½ cup
Watercress ½ cup Tomato 1 medium
Tomato juice, unsalted ½ cup
Medium potassium (101-200 mg) Tomato juice, canned with saltc ½ cup
Artichoke ½ cup Tomato puree 2 tbsp
Broccoli ½ cup Tomato sauce ¼ cup
Cabbage, cooked ½ cup Vegetable juice cocktail, unsalted ½ cup
Carrots, raw 1 small Vegetable juice cocktail, canned
Cauliflower ½ cup with saltc ½ cup
Celery, raw 1 stalk Bamboo shoots, fresh cookedd ½ cup
Collards ½ cup Beet greensd ¼ cup
Corna ½ cup or 1 small ear Chard, cookedd ½ cup
Eggplant ½ cup Chinese cabbage, cookedd ½ cup
Kale ½ cup Potato, bakedd ½ medium
Mushrooms, canneda ½ cup Potato, hashed brownd ½ cup
Mushrooms, fresh raw ½ cup Potato chipsd 1 oz, 14 chips
Mustard greens ½ cup Spinach, cookedd,e ½ cup
Onions ½ cup Sweet potatod,e ½ cup
Peas, greena ½ cup Tomato pasted 2 tbsp
Radishes ½ cup Winter squashd ¼ cup
Sauerkrautb ½ cup
Snow peasa ½ cup
Spinach, raw ½ cup Prepared or Canned With Salt
Squash, summer ½ cup Vegetables canned with salt (use serving size listed above) e
Turnip greens ½ cup
Turnips a
High phosphorus.
b
High sodium — each serving counts as 1 Vegetable
choice and 3 Salt choices.
c
High sodium — each serving counts as 1 Vegetable
choice and 2 Salt choices.
d
Very high potassium.
e
High sodium — each serving counts as 1 Vegetable
choice and 1 Salt choice.

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FRUIT CHOICES
1 choice = 0.5 g protein
= 70 kcal
= 15 mg phosphorus
Fruit Amount Fruit Amount
Low potassium (0-100 mg) High potassium (201-350 mg)
Apple sauce ½ cup Apricots, canned or fresh 2 halves
Blueberries ½ cup Apricots, dried 5
Cranberries 1 cup Cantaloupe 1/8 small
Cranberry juice cocktail 1 cup Dates ¼ cup
Grape juice ½ cup Figs, dried 2 whole
Lemon ½ Honeydew melon 1/8 small
Papaya nectar ½ cup Kiwifruit ½ medium
Peach nectar ½ cup Nectarine 1 small, 2-inch
Pears, canned ½ cup diameter
Pear nectar ½ cup Orange juice ½ cup
Medium potassium (101-200 mg) Orange 1 small, 2½-inch
Apple 1 small, 2½-inch diameter
diameter Pear, fresh 1 medium
Apple juice ½ cup Bananaa ½ medium
Apricot nectar ½ cup Prune juicea ½ cup
Blackberries ½ cup Prunes, dried or canneda 5
Cherries, sour or sweet ½ cup a
Figs, canned ½ cup Very high potassium.
Fruit cocktail ½ cup
Grapes 15 small
Grapefruit ½ small
Grapefruit juice ½ cup
Gooseberries ½ cup
Lemon juice ½ cup
Mango ½ cup
Papaya ½ cup
Peach, canned ½ cup
Peach, fresh 1 small, 2-inch diameter
Pineapple, canned or fresh ½ cup
Plums, canned or fresh 1 medium
Raisins 2 tbsp
Raspberries ½ cup
Rhubarb ½ cup
Strawberries ½ cup
Tangerine 1 medium, 2 ½-inch
diameter
Watermelon 1 cup

FAT CHOICES
1 choice = 45 kcal
= 55 mg sodium
= 10 mg potassium
= 5 mg phosphorus
Unsaturated Fats Amount Saturated Fats Amount
Margarine 1 tsp Butter 1 tsp
Reduced-calorie margarine 1 tbsp Coconut 2 tbsp
Mayonnaise 1 tsp Powdered coffee whitener 1 tbsp
Low-calorie mayonnaise 1 tbsp Solid shortening 1 tsp
Oil (safflower, sunflower, corn,
Soybean, olive, peanut, canola) 1 tsp
Salad dressing (mayonnaise-type) 2 tsp
Salad dressing (oil-type) 1 tbsp

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Fat Choices (con’t)

Unsaturated Fats (con’t) Amount
b
High sodium — each serving counts as 1 Fat choice and 1
Low-calorie salad dressing 2 tbsp Salt choice.
(mayonnaise-type)
Low-calorie salad dressing (oil-type)b 2 tbsp
Tartar sauce 1½ tsp
HIGH-CALORIE CHOICES
1 choice = trace protein
=100 kcal
= 15 g sodium
= 20 mg potassium
= 5 mg phosphorus

Beverages Amount Candies and Sweets Amount

Carbonated beverages (fruit flavors, Butter mints 14
root beer, colas, or pepper-type) a 1 cup Candy corn 20 or 1 oz
Kool-Aid 1 cup Chewy fruit snacks 1 pouch
Limeade 1 cup Cranberry sauce or relish ¼ cup
Lemonade 1 cup Fruit chews 4
Fruit-flavored drink 1 cup Fruit Roll Ups 2
Tang 1 cup Gumdrops 15 small
Wineb ½ cup Hard candy 4 pieces
Honey 2 tbsp
Frozen Desserts Jam or jelly 2 tbsp
Fruit ice ½ cup Jelly beans 10
Juice bar (3 oz) 1 bar LifeSavers or cough drops 12
Popsicle (3 oz) 1 bar Marmalade 2 tbsp
Sorbet ½ cup Marshmallows 5 large
Sugar, brown or white 2 tbsp
The following foods are high in poor-quality protein and/or Sugar, powdered 3 tbsp
phosphorus. They should be used only when advised by the Syrup 2 tbsp
dietitian.
Beerb
Chocolate
Nuts and nut butters
a
High phosphorus.
b
Check with your physician before using alcohol.

SALT CHOICES
1 choice = 250 mg sodium
Salt Choices Amount
Salt 1/8 tsp
Seasoned salts (eg, onion, garlic) 1/8 tsp
Accent ¼ tsp
Barbecue sauce 2 tbsp
Bouillon 1/3 cup
Catsup 1½ tbsp
Chili sauce 1½ tbsp
Dill pickle 1/6 of large or ½ oz
Mustard 4 tsp
Olives, green 2 medium or 1/3 oz
Olives, black 3 large or 1 oz
Soy sauce ¾ tsp
Light soy sauce 1 tsp
Steak sauce 2½ tsp
Sweet pickle relish 2½ tbsp
Taco sauce 2 tbsp
Tamari sauce ¾ tsp
Teriyaki sauce 1¼ tsp
Worcestershire sauce 1 tbsp

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 Medical Nutrition Therapy for Renal Disease

HEALTHY FOOD GUIDE FOR DIABETES AND KIDNEY DISEASE

MILK CHOICES
1 choice = 4 g protein 1 choice= 0.5 g protein
= 8 g carbohydrate = 12 g carbohydrate
= 100 kcal = 140 kcal
= 80 mg sodium = 40 mg sodium
= 185 mg potassium = 80 mg potassium
= 110 mg phosphorus = 30 mg phosphorus
Milk Choices Amount Nondairy Milk Substitutes Amount
Milk (nonfat, low-fat, whole) ½ cup Dessert, nondairy frozen ½ cup
Lo Pro 1 cup Dessert topping, nondairy frozen ½ cup
Buttermilk, cultured ½ cup Liquid nondairy creamer,
Chocolate milk ½ cup Polyunsaturated ½ cup
Light cream or half-and-half ½ cup
Ice milk or ice cream ½ cup
Yogurt, plain or fruit-flavored ½ cup
Evaporated milk ¼ cup
Cream cheese 3 tbsp
Sour cream 4 tbsp

MEAT CHOICES
1 choice = 7 g protein
= 65 kcal
= 25 mg sodium
= 100 mg potassium
= 65 mg phosphorus
Prepared without added salt
Meat Amount Meat Amount
Beef 1 oz Beef 1 oz
Round, sirloin, flank, cubed, Deli-style roast beefb
T-bone and porterhouse steak; Pork 1 oz
tenderloin, rib, chuck, and rump Boiled or deli-style hamb
roast; ground beef or ground chuck Poultry 1 oz
Pork 1 oz Deli-style chicken or turkeyb
Fresh ham; tenderloin, Fish
Chops; loin roast; cutlets Canned tuna; canned salmonb 1 oz
Lamb 1 oz Sardinesa,b 1 oz
Chops; leg; roasts Cheese
Veal 1 oz Cottageb ¼ cup
Chops; roasts; cutlets
Poultry 1 oz
Chicken; turkey; Cornish Meat/Protein Sources to Avoid:
Hen; domestic duck and goose
Fish • Bacon
Fresh and frozen fish 1 oz • Black beans, black-eyed peas, great northern beans,
Lobster; scallops; shrimp; clams 1 oz • lentils, lima beans, navy beans, pinto beans, red kidney
Crab; oysters 1½ oz beans, soybeans, split peas, turtle beans
Canned tuna, canned salmon 1 oz • Frankfurters; bratwurst; Polish sausage
(canned without salt) • Luncheon meats, including bologna, braunschweiger,
Sardines (canned without salt) a 1 oz liverwurst, picnic loaf, summer sausage, and salami
Wild game 1 oz • Nuts and nut butters
Venison; rabbit; squirrel; • All cheeses except cottage cheese
Pheasant; duck; goose
Egg a
High phosphorus.
Whole 1 large b
High sodium — each serving counts as 1 Meat choice and 1
Egg white or yolk 2 large Salt choice.
Low-cholesterol egg product ¼ cup
Chitterlings 2 oz
Organ meatsa 1 oz

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STARCH CHOICES
1 choice = 2 g protein
= 15 g carbohydrate
= 80 kcal
= 80 mg sodium
= 35 mg potassium
= 35 mg phosphorus

Breads and Rolls Amount Cereals and Grains Amount

Prepared without added salt Cereals, ready-to-eat, most brandsa ¾ cup

Bread (French, Italian, raisin, 1 slice (1 oz) Puffed rice 2 cups
light rye, sourdough, white) Puffed wheat 1 cup
Bagel ½ small Cereals, cooked
Bun, hamburger or hot dog type ½ Cream of Rice or Wheat, ½ cup
Dinner roll or hard roll 1 small Farina, Malt-O-Meal
English muffin ½ Oat bran or oatmeal, Ralston 1/3 cup
Muffin, no nuts, bran, or whole wheat ½ small (1 oz) Cornmeal, cooked ¾ cup
Pancakea,b 1 small (1 oz) Grits, cooked ½ cup
Pita or “pocket” bread ½ 6-inch diameter
Flour, all-purpose 2½ tbsp
Tortilla, corn 2 6-inch diameter Pasta (noodles, macaroni,
Tortilla, flour 1 6-inch diameter spaghetti), cooked ½ cup
Wafflea,b 1 small (1 oz) Pasta made with egg (egg noodles),
cooked 1/3 cup
Rice, white or brown, cooked ½ cup
Crackers and Snacks Desserts
Crackers: saltines, round butter 4 crackers Cake, angel food 1 oz
Graham crackers 3 squares Shortbread cookie 3 cookies
Melba toast 3 oblong Sugar cookie 3 cookies
RyKrispa 3 crackers Sugar wafer 2 cookies
Popcorn, plain 1½ cup popped Vanilla wafer 5 cookies
Potato chips 1 oz, 14 chips Sweetened gelatin ½ cup
Tortilla chips ¾ oz, 9 chips
Pretzels, sticks or ringsa ¾ oz 10 sticks
Pretzels, sticks or rings, unsalted ¾ oz, 10 sticks

Starches to Avoid

• Bran cereal or muffins; Grape-Nuts cereal; granola

cereal or bars
• Boxed, frozen, or canned meals; entrees; or side dishes
• Black beans, black-eyed peas, great northern beans,
lentils, lima beans, navy beans, pinto beans, red kidney
beans, soybeans, split peas, turtle beans a
• Pumpernickel, dark rye, whole wheat, or oatmeal bread High sodium — each serving counts as 1 Starch choice
• Whole wheat cereals b and 1 Salt choice.
• Whole wheat crackers High phosphorus.

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VEGETABLE CHOICES
1 choice = 1 g protein
= 25 kcal
= 5 g carbohydrates
= 15 mg sodium
= 20 mg phosphorus

Prepared or canned without added salt

unless otherwise indicated

Vegetables Amount Vegetables Amount

Low Potassium (0-100 mg) High potassium (201-350 mg)
Alfalfa sprouts 1 cup Asparagus a 5 spears
Bamboo shoots, canned ½ cup Avocado ¼ whole
Beans, green or wax ½ cup Beets ½ cup
Bean sprouts ½ cup Brussels sprouts a ½ cup
Cabbage, raw ½ cup Celery, cooked ½ cup
Chinese cabbage, raw ½ cup Kohlrabi ½ cup
Chard, raw ½ cup Mushrooms, fresh cooked a ½ cup
Cucumber, peeled ½ cup Okra a ½ cup
Endive ½ cup Parsnips a ½ cup
Escarole ½ cup Pepper, chili ½ cup
Lettuce, all varieties 1 cup Potato, boiled or mashed ½ cup
Pepper, green, sweet ½ cup Pumpkin ½ cup
Water chestnuts, canned ½ cup Rutabagas a ½ cup
Watercress ½ cup Tomato 1 medium
Tomato juice, unsalted ½ cup
Medium potassium (101-200 mg) Tomato juice, canned with saltc ½ cup
Artichoke ½ cup Tomato puree 2 tbsp
Broccoli ½ cup Tomato sauce ¼ cup
Cabbage, cooked ½ cup Vegetable juice cocktail, unsalted ½ cup
Carrots, raw 1 small Vegetable juice cocktail, with saltc ½ cup
Cauliflower ½ cup Bamboo shoots, fresh cookedd ½ cup
Celery, raw 1 stalk Beet greensd ¼ cup
Collards ½ cup Chard, cookedd ½ cup
Corn a ½ cup or 1 small ear Chinese cabbage, cookedd ½ cup
Eggplant ½ cup Potato, bakedd ½ medium
Kale ½ cup Potato, hashed brownd ½ cup
Mushrooms, canned a ½ cup Potato chipsd 1 oz, 14 chips
Mushrooms, fresh raw ½ cup Spinach, cookedd,e ½ cup
Mustard greens ½ cup Sweet potatod,e ½ cup
Onions ½ cup Tomato pasted 2 tbsp
Peas, green a ½ cup Winter squashd ¼ cup
Radishes ½ cup
Sauerkrautb ½ cup
Snow peas a ½ cup Prepared or Canned With Salt
Spinach, raw ½ cup Vegetables canned with salt (use serving size listed above) e
Squash, summer ½ cup a
Turnip greens ½ cup High phosphorus.
b
Turnips ½ cup High sodium — each serving counts as 1 Vegetable
choice and 3 Salt choices.
c
High sodium — each serving counts as 1 Vegetable
choice and 2 Salt choices.
d
Very high potassium.
e
High sodium — each serving counts as 1 Vegetable choice
and 1 Salt choice.

Manual of Clinical Nutrition Management G-23 © Morrison Management Specialists, Inc.

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 Medical Nutrition Therapy for Renal Disease

FRUIT CHOICES
1 choice = 0.5 g protein
= 15 g carbohydrate
= 60 kcal
= 15 mg phosphorus

Fruit Amount Fruit Amount

Low potassium (0-100 mg)
Apple sauce ½ cup Apricots, canned or fresh 2 halves
Blueberries ½ cup Apricots, dried 5
Cranberries 1 cup Cantaloupe 1/8 small
Cranberry juice cocktail 1 cup Dates ¼ cup
Grape juice ½ cup Figs, dried 2 whole
Lemon ½ Honeydew melon 1/8 small
Papaya nectar ½ cup Kiwifruit ½ medium
Peach nectar ½ cup Nectarine 1 small, 2-inch
Pears, canned ½ cup diameter
Pear nectar ½ cup Orange juice ½ cup
Medium potassium (101-200 mg) Orange 1 small, 2½-inch
Apple 1 small, 2½-inch diameter diameter
Apple juice ½ cup Pear, fresh 1 medium
Apricot nectar ½ cup Bananaa ½ medium
Blackberries ½ cup Prune juicea ½ cup
Cherries, sour or sweet ½ cup
Figs, canned ½ cup
Fruit cocktail ½ cup
Grapes 15 small
Grapefruit ½ small
Grapefruit juice ½ cup
Gooseberries ½ cup
Lemon juice ½ cup
Mango ½ cup
Papaya ½ cup
Peach, canned ½ cup
Peach, fresh 1 small, 2-inch diameter
Pineapple, canned or fresh ½ cup
Plums, canned or fresh 1 medium
Raisins 2 tbsp
Raspberries ½ cup
Rhubarb ½ cup
Strawberries ½ cup
Tangerine 1 medium, 2½-inch
diameter
Watermelon 1 cup

Manual of Clinical Nutrition Management G-24 © Morrison Management Specialists, Inc.

Developed by the Morrison Healthcare Food Services division
 Medical Nutrition Therapy for Renal Disease

FAT CHOICES
1 choice = 45 kcal
= 55 mg sodium
= 10 mg potassium
= 5 mg phosphorus

Unsaturated Fats Amount Saturated Fats Amount

Margarine 1 tsp Butter 1 tsp
Reduced-calorie margarine 1 tbsp Coconut 2 tbsp
Mayonnaise 1 tsp Powdered coffee whitener 1 tbsp
Low-calorie mayonnaise 1 tbsp Solid shortening 1 tsp
Oil (safflower, sunflower, corn,
Soybean, olive, peanut, canola) 1 tsp
Salad dressing (mayonnaise-type) 2 tsp
Salad dressing (oil-type) 1 tbsp
Low-calorie salad dressing 2 tbsp
(mayonnaise-type)

Unsaturated Fats Amount

Low-calorie salad dressing (oil-type) b 2 tbsp
Tartar sauce 1½ tsp b
High sodium — each serving counts as 1 Fat choice and
1 Salt choice.

HIGH-CALORIE CHOICES
1 choice = trace protein
= 15 g carbohydrate
= 60 kcal
= 15 mg sodium
= 20 mg potassium
= 5 mg phosphorus

Beverages Amount Candies and Sweets Amount

Carbonated beverages (fruit flavors, Butter mints 8

root beer, colas, or pepper-type) a ½ cup Candy corn 12
Kool-Aid ½ cup Chewy fruit snacks ½ pouch
Limeade ½ cup Cranberry sauce or relish 2 tbsp
Lemonade ½ cup Fruit chews 3
Cranberry juice cocktail (low-calorie) ½ cup Fruit Roll Ups 1
Tang ½ cup Gumdrops 9 small
Fruit-flavored drink ½ cup Hard candy 3 pieces
Wineb ¼ cup Honey 1 tbsp
Jam or jelly 1 tbsp
Frozen Desserts Amount Jelly beans 6
Fruit ice ¼ cup LifeSavers or cough drops 8
Juice bar (3 oz) 1 bar Marmalade 1 tbsp
Popsicle (3 oz) 1 bar Marshmallows 3 large
Sorbet ¼ cup Sugar, brown or white 4 tsp
Sugar, powdered 2 tbsp
The following foods are high in poor-quality protein and/or Syrup 1 tbsp
phosphorus. They should be used only when advised by the
dietitian.
Beerb
Chocolate
Nuts and nut butters
a
High phosphorus.
b
Check with your physician before using alcohol.

Manual of Clinical Nutrition Management G-25 © Morrison Management Specialists, Inc.

Developed by the Morrison Healthcare Food Services division
 Medical Nutrition Therapy for Renal Disease

SALT CHOICES
1 choice = 250 mg sodium

Salt Choice Amount

Salt 1/8 tsp

Seasoned salts (eg, onion, garlic) 1/8 tsp
Accent ¼ tsp
Barbecue sauce 2 tbsp
Bouillon 1/3 cup
Catsup 1½ tbsp
Chili sauce 1½ tbsp
Dill pickle 1/6 large or ½ oz
Mustard 4 tsp
Olives, green 2 medium or 1/3 oz
Olives, black 3 large or 1 oz
Soy sauce ¾ tsp
Light soy sauce 1 tsp
Steak sauce 2½ tsp
Taco sauce 2 tbsp
Tamari sauce ¾ tsp
Teriyaki sauce 1¼ tsp
Worcestershire sauce 1 tbsp

Manual of Clinical Nutrition Management G-26 © Morrison Management Specialists, Inc.

Developed by the Morrison Healthcare Food Services division