Cheese And Kidney Disease: What's Safe To Eat?

Many cheeses are high in phosphorus and sodium, which can be problematic for people with kidney disease. However, this does not mean that people with kidney disease need to cut cheese out of their diet entirely. The key is to choose low-phosphorus cheeses and to be mindful of portion sizes. The amount and type of cheese that can be consumed will depend on the individual's stage of kidney disease and the type of dialysis they are receiving. Some examples of kidney-friendly cheeses include Monterey Jack, Parmesan, low-sodium cheddar or Colby, cream cheese, goat cheese, natural sharp cheddar, Swiss cheese, and ricotta.

Low-phosphorus cheeses

Cheese is a good source of calcium, protein, vitamin B12, and vitamin A. However, many cheeses are high in phosphorus and sodium, which can be problematic for people with kidney disease. The good news is that some cheeses are lower in phosphorus and sodium and can be safely enjoyed by people with kidney disease. Here are some tips and recommendations for choosing and enjoying low-phosphorus cheeses:

Understanding Phosphorus and Kidney Disease:

Phosphorus is a mineral that plays an important role in bone health and energy production. While phosphorus is essential for the body, too much phosphorus can be harmful to people with kidney disease. People with kidney disease may have difficulty removing excess phosphorus from the body, which can lead to high phosphorus levels in the blood. High phosphorus levels can cause calcium to be pulled from the bones, leading to bone weakness and an increased risk of fractures. Additionally, high phosphorus levels can bind to calcium in the blood, forming calcium-phosphorus deposits that can damage the body's organs and blood vessels.

Choosing Low-Phosphorus Cheeses:

When selecting cheese, it is important to read the ingredient list and look for cheeses with no added phosphates. Phosphorus additives are often included in processed cheese products, such as American cheese, to improve melting and texture. These additives can significantly increase the phosphorus content of the cheese. Look for cheeses with no ingredients containing the letters "PHOS."

Some examples of low-phosphorus cheeses include:

• Cream Cheese: Cream cheese is a good option as it is lower in phosphorus and protein. Look for full-fat cream cheese and avoid reduced-fat or fat-free versions, which may contain phosphorus additives.
• Goat Cheese: Soft goat cheese, or chèvre, is naturally low in phosphorus and sodium. It is also a good source of calcium and protein.
• Swiss Cheese: Swiss cheese is one of the lowest sodium cheeses available. It is also typically free of phosphorus additives, making it a good choice for people with kidney disease.
• Ricotta Cheese: Whole milk ricotta cheese is higher in potassium and protein but does not usually contain phosphorus additives. Pair it with low-protein foods like fruits to balance your meal.
• Parmesan Cheese: Grated Parmesan cheese is a good low-phosphorus option, but it is high in sodium, so it should be enjoyed in moderation. Look for refrigerated Parmesan cheese, as the kind that does not require refrigeration often contains phosphorus additives.
• Cheddar Cheese: While cheddar cheese is typically high in sodium, you can find low-sodium versions. Real cheddar cheese does not usually contain phosphorus additives, but be cautious with "singles" or processed cheddar cheese products, which are often high in phosphorus.
• Feta Cheese: Feta cheese is very high in sodium, so it should be enjoyed in moderation. It is a high-protein food but does not contain phosphorus additives and is low in potassium.
• Mozzarella Cheese: Mozzarella cheese can be a good option, but some varieties may contain phosphorus additives. Whole milk mozzarella is higher in protein but lower in potassium.

Incorporating Low-Phosphorus Cheeses into Your Diet:

When incorporating cheese into your diet, it is important to consider your overall daily intake of phosphorus, sodium, and protein. Here are some tips for including low-phosphorus cheeses in your kidney-friendly diet:

• Mindful Portions: Pay attention to portion sizes and limit your intake of cheese to one or two servings per day. The recommended serving size for cheese is typically 30 grams or 1 ounce, which is about the size of your thumb.
• Frequency: Enjoy cheese in moderation and be mindful of how often you include it in your meals. You may not want to have multiple high-phosphorus foods in the same day, as it can increase your phosphorus levels.
• Pairing: Pair cheese with other low-sodium and low-phosphorus foods. For example, enjoy cheese with sliced cucumbers, whole wheat crackers, or fruit.
• Lab Results: Work with your healthcare team and monitor your lab results. Your kidney dietitian will advise you on whether you need to limit phosphorus, sodium, or protein based on your individual needs and lab results.
• Dialysis: If you are on dialysis, your phosphorus and fluid removal may impact how much cheese you can include in your diet. Talk to your kidney dietitian about how to safely incorporate cheese.

Sample Snacks and Recipes:

• Cream cheese and sliced cucumber on a whole wheat bagel.
• Ricotta on toast with honey and berries.
• Greek salad with feta cheese, bell peppers, cucumbers, and cherry tomatoes.
• Tuna salad sandwich with a slice of Swiss cheese.
• Cottage cheese with sliced apples and cinnamon.
• Air-popped popcorn sprinkled with shredded Parmesan cheese.
• Macaroni and cheese made with low-sodium cheddar or Colby cheese.

Recommended sodium intake

Cheese is a beloved food for many, but it can be problematic for people with kidney disease. However, with the right choices and mindful consumption, it is possible to safely include some cheese in your diet. The recommended sodium intake for Chronic Kidney Disease (CKD) is 2300 mg per day. Thus, it is important to opt for low-sodium cheese options and monitor your overall sodium intake. Here are some guidelines and recommendations for choosing kidney-friendly cheese:

Understanding Sodium in Cheese:

• Sodium Content: Cheese is typically high in sodium, and the majority of cheeses will fall into this category. When examining nutrition labels, look for cheeses with fewer milligrams of sodium than calories to identify lower-sodium options.
• Low-Sodium Cheese Options: Swiss cheese is naturally low in sodium, making it an excellent choice. Additionally, some cheeses are available in low-sodium versions. You can also pair high-sodium cheese with other low-sodium foods to balance out the overall sodium content of a dish.
• High-Sodium Cheeses to Limit: Stay away from cheese "singles" and American cheese, as these tend to be extremely high in sodium and phosphorus. Reduced-fat or fat-free cheeses are also more likely to have higher sodium and phosphorus content.

Choosing Kidney-Friendly Cheese:

• Read the Label: When selecting cheese, carefully read the ingredient list and nutrition facts. Look for cheeses with no phosphorus additives, as these can significantly increase the phosphorus content.
• Low-Phosphorus Cheeses: Opt for cheeses like cream cheese, brie, parmesan, and goat cheese, which are naturally lower in phosphorus.
• Serving Size: Remember that the recommended serving size for cheese is generally one ounce, or about the size of your thumb.
• Dialysis Considerations: If you are on dialysis, your protein requirements may be higher, so the protein content of cheese is less of a concern. However, it is still crucial to monitor your sodium, phosphorus, and potassium intake.
• Kidney-Friendly Snacks: There are many tasty snacks you can make with kidney-friendly cheeses, such as cream cheese with sliced cucumber on a whole wheat bagel, ricotta on toast with honey and berries, or cottage cheese with sliced apples and cinnamon.

Additional Considerations:

• Calcium Levels: If your calcium levels are high, consult your dietitian or doctor to review your medications and supplements. They may recommend adjustments or discontinuing certain products. If your calcium levels are within range, one to two servings of low-sodium, no-phosphorus-additive cheese per day are likely acceptable.
• Protein Content: If you are not on dialysis and have been advised to follow a lower-protein diet, remember that cheese is high in protein. Carefully plan your portions and consider plant-based protein options to reduce acid production in your body.
• Dialysis and Transplant: For kidney transplant recipients, it is recommended to avoid all unpasteurized dairy products due to the risk of foodborne illnesses. Always consult your healthcare team for personalized advice regarding your specific condition and dietary needs.

Dialysis and cheese

For those undergoing dialysis, cheese can be incorporated into the renal diet, but it is important to do your research. Many cheeses are high in phosphorus, sodium, and saturated fat, which can be dangerous for those with kidney disease. However, there are lower phosphorus and sodium cheeses that can be enjoyed in moderation.

Phosphorus

Phosphorus is not typically listed on cheese labels, but dairy products are usually high in phosphorus. Some cheeses have phosphorus additives, which should be avoided. These additives are usually found in processed cheese sauce, canned spray cheese, pasteurized cheese products, and processed American cheese.

Sodium

Cheese is also known to be high in sodium, but there are varieties that are lower in sodium content. In general, limiting hard and processed cheeses will help keep sodium intake down. Some processed cheeses have over 400 mg of sodium per ounce.

Potassium

Potassium in cheese is typically low. However, potassium chloride may be added to some low-sodium cheese options, such as low-sodium cheddar or Colby cheese.

When choosing cheese, opt for those with no added phosphates and lower sodium content. Here are some examples:

• Cream cheese
• Sharp cheddar
• Shredded parmesan
• Brie
• Goat cheese (soft)
• Natural Swiss cheese
• Ricotta
• Monterey jack cheese
• Grated parmesan
• Low-sodium cheddar or Colby cheese

It is recommended to avoid the following:

• Singles and American cheese
• Reduced-fat or fat-free cheese
• Highly processed cheeses
• Feta
• Parmesan
• Mozzarella with phosphorus additives

Calcium oxalate stones

Oxalate is a natural substance found in many foods. After your body uses what it needs, waste products travel through the bloodstream to the kidneys and are removed through urine. If there is too much waste in too little liquid, crystals can begin to form. These crystals may stick together and form a solid mass (a kidney stone). Oxalate is one type of substance that can form crystals in the urine. This can happen if there is too much oxalate, too little liquid, and the oxalate “sticks” to calcium while urine is being made by the kidneys.

To lower your chances of forming calcium oxalate stones, it is important to drink enough fluids, like water. Drinking enough fluids will thin out your urine and make it harder for chemicals to build up and form crystals. It is also recommended to eat less salt (sodium) as a diet high in salt causes calcium to build up in your urine. Too much calcium in your urine can lead to new stones and can also cause your bones to weaken.

Although it may seem counterintuitive, it is important to include the right amount of calcium in your diet. Calcium is a nutrient that is found in dairy products, such as yogurt, milk, and cheese. You need to eat calcium so that it can bind with oxalate in the stomach and intestines before it moves to the kidneys. Eating foods with calcium is a good way for oxalates to leave the body and not form stones. The best way to get calcium into your body is through the foods you eat. However, it is important to note that calcium in the form of a supplement may raise your chances of forming new calcium oxalate stones. Therefore, speaking with your healthcare provider will help you find the best way to include calcium in your diet.

It is also recommended to limit vitamin C supplements as too much vitamin C can cause high amounts of oxalate in the urine. In addition, eating less oxalate-rich foods may help lower your chances of forming new stones. Some foods that are very high in oxalate include baked potatoes with skin and bran cereals. However, it is important to note that you should not cut out all oxalate-rich foods as this can lead to poor nutrition and other health problems. Instead, eat and drink calcium and oxalate-rich foods together during a meal. Doing this helps oxalate and calcium “bind” to one another in the stomach and intestines before reaching the kidneys, making it less likely for kidney stones to form in the urine.

Non-dairy cheese

If you're a lover of cheese but are concerned about your kidney health, you may want to consider non-dairy cheese as an alternative. Non-dairy cheese can be a good option for people with kidney disease, but it's important to carefully read labels and watch your portions. Here's what you need to know about incorporating non-dairy cheese into a kidney-friendly diet:

Choosing Non-Dairy Cheese

When selecting non-dairy cheese, it's crucial to read the nutrition label and ingredient list. Look for products that are low in sodium, potassium, and phosphorus. Specifically, aim for options that have:

• Less than 150 mg of sodium per serving
• Less than 150 mg of potassium per serving (if listed)
• Less than 63 mg of phosphorus per serving (if listed)

Be cautious of additives in non-dairy cheese. Avoid products that contain "potassium" or "phosphate" in the ingredient list, as these can significantly increase the levels of these minerals. For example, an ingredient list that includes "dipotassium phosphate" indicates the presence of both potassium and phosphate additives.

Examples of Non-Dairy Cheese

There are a variety of non-dairy or vegan cheeses available in grocery and health food stores. Some common types of non-dairy cheese include:

• Soy-based cheeses
• Almond-based cheeses
• Rice-based cheeses
• Cashew-based cheeses
• Coconut-based cheeses
• Oat-based cheeses

Considerations for Kidney Disease

If you have kidney disease, it's important to be mindful of the protein, phosphorus, and sodium content in non-dairy cheese. Here are some key considerations:

• Protein: Non-dairy cheese can vary in protein content. While some types may be lower in protein, others may be just as high as dairy cheese. Balance your non-dairy cheese consumption with your daily protein allowance.
• Phosphorus: Non-dairy cheese can contain phosphorus additives, so it's important to check the ingredient list. Look for ingredients that contain the letters "PHOS" and avoid those products.
• Sodium: Non-dairy cheese can also be high in sodium, so opt for reduced-sodium options. Check the nutrition label and choose products with less than 150 mg of sodium per serving.

Portion Control

Remember that portion control is crucial when consuming non-dairy cheese with kidney disease. The recommended serving size for cheese is 1 ounce, which is about one slice or a small handful of shredded cheese. Incorporate non-dairy cheese into your diet in moderation and always consult with a renal dietitian to determine the appropriate portions for your specific needs.

Frequently asked questions