Is There Anything On The Menu I Can Eat?
After starting dialysis, eating out on a renal diet may seem like an impossible option. Things become more complicated. What is safe to eat? What contains hidden phosphorus and potassium? How can I avoid eating too much salt and gaining a bunch of fluid weight? All of these concerns kind of take the fun out of eating out, right?
It can seem discouraging at first, but it is possible! It just takes more planning and maybe making some adjustments to what you used to order to make it a healthier fit. If you’re used to eating out everyday then now is probably a better time to learn to eat out less and make more healthier meals at home. Once you become more comfortable with making kidney friendly meals at home and you’re ready to treat yourself on occasion then this blog is for you!
Tips & Tricks
You’re ready to make more dialysis friendly choices when you eat out that better support your health, but where do you start? It’s pretty much a given that when you eat out you are going to be consuming higher amounts of sodium, phosphorus, potassium and unhealthy fats than what you would typically eat at home. Keeping that in mind, here are a few Tips & Tricks that will help get you started.
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Don’t feel shy about asking to hold the salt and bring your own seasoning with you! For some good salt free herb blend options try Spiceology or Bragg Organic Sprinkle*. For a lower sodium substitute for soy sauce try Coconut Aminos*. A good salt free hot sauce option is Dave’s Gourmet Total Insanity Hot Sauce* or Palo Alto Firefighter’s Pepper Sauce. You can always put a small amount in a little plastic container to be more on the sly. You are just being smart and planning ahead so you can still enjoy your food with no regrets!
Ethnic Food Guide
When eating out, you have a variety of cuisine options to choose from depending on your preference. We’ll start with my favorite.
Who doesn’t love tacos? I love Mexican food, but it can be pretty high in sodium, potassium, and phosphorus. Some foods to watch out for:
- Salted fried tortilla chips. So addicting and loaded with salt and unhealthy fats. If you’re like me and can’t stop at just a handful, it’s best to avoid.
- Salsas and tomato based sauces
- Chili con carne (kidney beans, meat, and tomato sauce)
- Quesadillas, cheese enchiladas, chile relleno
- Tomales (save for special occasions)
- Refried beans
What’s left to eat, right? So many yummy dishes, yet not so kidney friendly. Your Best Bets:
- Tacos. Choose beef, chicken, fish, shrimp, or veggie taco (with black/pinto beans), cilantro, lettuce/cabbage, onions, sour cream. A good time to add your salt free hot sauce!
- Fajitas. Beef or chicken. They usually come with sautéed onions and bell peppers which are low in potassium. You can make a veggie fajita by skipping the meat and adding mushrooms, zucchini. Choose side of rice and skip the beans on this one.
- Chicken or beef enchiladas with verde sauce (light on the sauce).
Burritos with flour tortillas can be pretty high in sodium and added phosphorus. Add in higher sodium meats like shredded carnitas and chorizo and you will be consuming most of your daily sodium goal just with the burrito alone. Instead, try chicken or steak burritos with rice, lettuce/cabbage, onions and add your own no salt hot sauce.
You can also add a small amount of tomatillo salsa for a splash of fun (tomatillos contain less potassium). If your potassium is well controlled and you are dying for some avo, instead of guacamole ask for a small side of sliced avocado and add a couple to your dish. A small amount can be OK, but having more than that can really raise your potassium levels.
Ahhh Italy……the birthplace of pizza and other yummy high phosphorus, potassium, and sodium entrees! But, don’t fret. There are still some options for you. Obviously pizza is not typically very dialysis friendly. If you do order it on occasion, I would choose a thin crust with pesto, onion, garlic, and if you’re a pineapple fan that could be a fun addition. You could also choose a vegetarian pizza (light on the cheese, no tomatoes, sun-dried tomatoes) which would at least avoid the processed salty meats like pepperoni and sausage. Have a couple of slices and balance it out with a salad.
Some foods to watch out for:
- Antipasti appetizer platters with cheese, olives, cured salty meats.
- Lasagna, Cannelloni, Ravioli, tortellini (all stuffed with cheese and typically with tomato sauce).
- Spaghetti/Pasta with marinara, napolitana, bolognese, cacciatore, or arrabiatta sauces (all tomato based sauces).
- Carbonara (pancetta, egg yolks, heavy cream, cheese), Alfredo pasta (cream, parmesan cheese).
- Eggplant Parmesan
Your Best Bets:
- Sourdough bread dipped in olive oil and balsamic vinegar (even better with crushed garlic added!).
- Mixed green salad (hold the tomatoes). Ask for no salad dressing and instead serve olive oil and balsamic vinegar on the side so you can control the sodium and add your own salt free seasoning.
- Pesto pasta (no added parmesan).
- Capellini or angel hair pasta with olive oil, garlic, basil, but instead of the pomodoro (fresh tomatoes) ask for zucchini, bell pepper, or eggplant with option to add shrimp or a meat of your choice.
- Pasta primavera (no tomatoes)
- Fresh fish or seafood
- Chicken piccata (lemon butter sauce)
Asian is a very broad term that can cover many different countries and cuisines. We will look at three: Chinese, Thai, and Japanese. All three use rice as a staple and soy sauce as a common high sodium condiment. This is a perfect time to bring your coconut aminos. Much lower in sodium than even low sodium soy sauce.
Chinese food staples include rice, noodles, vegetables, meat, chicken, eggs, and tofu. A favorite option for many when eating out, but it is often very high in sodium, unhealthy fats and sugar and frequently has added MSG (monosodium glutamate) as a flavor enhancer. When you order, ask if they can cook your dish without soy sauce, fish sauce, or MSG. Some foods to watch out for:
- I would avoid all soups. They are very high in sodium.
- Fried egg rolls.
- Fried rice, noodles.
- General Tso’s/orange/sweet and sour chicken, sweet and sour pork (deep fried meat smothered in sugary sauce)
- Barbecue Spare Ribs. Sounds innocent, but this is a high fat, sodium, and sugar entree.
- Kung Pao Chicken. High in sodium and contains peanuts.
Your Best Bets:
- Dim sum steamed dumplings
- Steamed rice. Ask for brown rice. It will give you more fiber and won’t spike your blood sugars as much.
- Buddha’s Delight (stir fried vegetables and tofu). You can ask for the steamed version without the sauce. Use your coconut aminos instead!
- Chop Suey (stir fried dish made with meat, eggs, vegetables). Order with chicken or shrimp with brown rice.
- Egg Foo Young. Ask for it to be lightly fried.
- Moo goo gai pan (chicken and vegetable stir fry). Ask for sauce on the side.
- Chicken or beef & broccoli. Light on sauce (or on the side).
I love a good Thai meal, but just like Chinese food, it is usually loaded with soy sauce, fish sauce, MSG, and unhealthy oils. Despite that, you can find healthier options for you. Some foods to watch out for:
- Deep fried egg rolls, wontons
- All soups
- Papaya salad (high in potassium)
- Thai curry dishes (red, green, yellow). They are high in sodium and use canned coconut milk as a base which is very high in potassium.
- Thai fried rice. Go for the healthier steamed version.
- Gluay kaeg (a fried banana dessert), fried ice cream
- Thai iced tea (made with sweetened condensed milk)
Your Best Bets:
- Fresh spring/summer rolls. Love these! They are usually served with peanut and sweet sauce, so go easy on the dipping. Avoid the fried kind.
- Steamed rice. Try brown rice if you’re feeling spunky.
- Larb chicken salad. Ask if you can have it prepared without the fish sauce.
- Pad Thai noodles with shrimp, chicken or tofu. Hold the peanuts and ask for light on the oil and sauce on the side (contains fish sauce). You can also order with a side of steamed vegetables.
- Beef and broccoli
- Steamed fish and vegetables
The traditional Japanese diet includes white rice, fish, fresh and pickled vegetables, seaweed, and tofu flavored with soy sauce and miso (a salty fermented soybean paste). Sushi is a staple dish which typically includes raw fish rolled up with vinegared rice, seaweed, and vegetables. It is possible, however, to have sushi without any raw fish in it. Eating Japanese food is another good occasion to bring your coconut aminos with you for a lower sodium dipping sauce.
Once you get a transplant you have to avoid raw fish (sashimi, raw fish sushi) because your immune system will be more suppressed. Foods that are more prone to causing food borne illness or parasitic infections are best avoided. Some say that dialysis patients should avoid eating raw fish for the same reason, but it is not a hard fast rule.
Some foods to watch out for:
- Wasabi (high in sodium and also contains potassium).
- Edamame (immature soy beans in the pod usually served steamed with salt). High in potassium.
- Ramen, soups (very high in sodium).
- Miso based dressings and soups.
- Natto (a breakfast food made from fermented soybeans). Very high in potassium.
- Seaweed salad (high in sodium, potassium, and typically MSG).
- Avoid sushi rolls served with a lot of sauce, avocado, nuts, yam.
Your Best Bets:
- Gyoza (small dumplings filled with meat and vegetables). Ask to have them steamed and hold the sauce.
- Onigiri rice balls (usually stuffed with meat or vegetables). Ask for no black sesame seeds.
- California roll (without avocado) and other rolls that include cooked eel, shrimp, or crab.
- Yakatori (grilled chicken skewers).
- Bento boxes. Usually containing rice, fish or meat and typically pickled vegetables. Watch your portions as it can be higher in sodium.
- Tempura. Not necessarily healthy as it is deep fried in light batter (usually vegetables, shrimp, prawns), but go ahead and treat yourself!
- Hibachi or teppanyaki style grilling (noodles, vegetables, meat, fish, tofu). Watch the sauce.
Indian food is full of traditional spices such as curry, turmeric, ginger, chilies, cumin, and coriander. Staple foods include rice, roti (whole wheat unleavened flatbread) or naan (leavened flatbread), and dal (a lentil based stew). This may be combined with a vegetable or a meat/chicken/seafood dish served with a yogurt sauce (raita), pickles, chutneys and relish condiments. I love a good Indian meal, but it is typically very high in sodium and potassium. Here are some foods to watch out for:
- Dal (lentil soups)
- Chicken tikka masala (tomato yogurt sauce)
- Malai kofta (vegetarian “meatballs” made from potato, nuts, paneer cheese, and served in a creamy tomato/nut based sauce)
- Chole chickpea curry. Most curries are going to be be high in sodium and potassium.
- Palak paneer (a curry made with spinach and Indian cottage cheese)
- Chaat (a crispy snack food usually with a fried cracker and topped with potatoes, tomatoes, chickpeas, yogurt and chutney)
- Rajma (kidney beans in a thick gravy)
- Lassi (a sweet yogurt drink with added milk and fruit)
Your Best Bets:
- Naan, Roti flatbread
- Meat Samosas (a deep fried pastry filled with meat or vegetables). The vegetable version contains potatoes and lentils, so it’s best to avoid.
- Momos (steamed filled dumpling)
- Tandoori chicken/meat/fish or eggplant. Prepared by roasting in a clay oven.
- Biryani (a mixed rice dish cooked with several spices and meat)
- Meat kebab dishes
- Gobi matar (cauliflower with peas). Order dry without the masala sauce.
I love Greece, it’s history and it’s food! Staples of the Greek diet include olive oil (the main ingredient used in most dishes), olives, feta cheese, Greek honey, fruits, legumes, vegetables, fresh herbs, yogurt, fish/seafood and lamb. The good news is that there are a lot of healthy options for dialysis patients! Some foods to watch out for:
- Moussaka: a layered casserole with tomato sauce and topped with bechamel (white sauce made from milk).
- Pastitsio: a baked dish similar to lasagna, with layers of pasta, tomato sauce, ground meat, topped with bechamel.
- Spanakopita: spinach pie with feta cheese, eggs, and herbs in a filo pastry.
- Saganaki: fried cheese seasoned with salt. High in sodium and phosphorus.
Your Best Bets:
- Greek salad. This includes feta cheese, onions, cucumbers, bell pepper. Ask for no tomatoes and plain olive oil instead of dressing.
- Dolma/dolmades: grape leaves stuffed with rice, herbs, and either vegetables or meat. Squeeze some lemon juice on top for added flavor.
- Hummus (made with ground chickpeas and tahini). Watch portions due to sodium and potassium content.
- Pita bread. As with all bread it will add to your sodium intake, but a small amount with your hummus is OK.
- Tabouli (Taubbouleh). A salad made of bulgar wheat, parsley, with a small amount of tomatoes, mint, onion, and seasoned with olive oil, lemon juice.
- Gyros: a popular street food. Rotisserie meat (usually lamb) in pita with onions, lettuce, tomato, and tzatziki (a yogurt sauce with garlic and cucumbers). It can be high in sodium and potassium. Ask for no tomatoes and tzatziki sauce on the side.
- Souvlaki or kebab. Grilled meat usually eaten straight off the skewer. Typically served with pita, vegetables, and tzatziki on the side.
- Fresh fish
- Couscous (pasta made of semolina and wheat flour). A good source of fiber and protein.
While this is my least favorite option when it comes to eating out, I also realize that because it’s so readily available, easy, and affordable, people are going to eat it. If you are used to eating fast food often, I encourage you to start cutting back and making healthier choices. While fast food is full of added sodium, phosphorus, unhealthy fats, processed meats, and jammed packed with calories and sugar, there are better choices over others, especially if you are on dialysis. Below are some better choices for a few popular options.
Starbucks is the biggest coffee chain in the world and a morning ritual for many people. Drink sizes usually range from tall (12 oz) to venti (20 oz), but there is a short size (8 oz) available – yay! You should stay clear from Frappuccinos. They contain from 37g to 83g of sugar depending on the size!
Your Best Bets:
Drinks. Choose Short (8 oz) or Tall (12 oz) – as your fluid allowance allows.
- Coffee, Caffè Americano (hot or iced)
- Shot of Espresso, Espresso Macchiato
- Cappuccino, Caffè Latte with almond or coconut milk (hot or iced)
- Chai/Black/Green/Herbal Tea
- Chai Tea Latte contains a lot of sugar, so go for the short size and request only 1 pump chai with almond or coconut milk.
- Matcha Green Tea Latte. Also high in sugar, so go for short and use a plant based milk.
- Cold/Nitro Cold Brew coffee
Breakfast (Avoid the wraps and breakfast sandwiches as most contain > 1000 mg of sodium).
- Kale and Portabella mushroom egg bites. While not the best, it is a better choice than breakfast sandwiches and other egg bite options.
- Hearty Blueberry Oatmeal (no dried fruit, nuts)
- Sprouted grain or cinnamon raisin bagel with side of cream cheese
- Butter croissant
- Petite vanilla bean scone
Lunch and snacks (Avoid sandwiches as most contain > 1000 mg of sodium).
- PB & J Protein Box (skip the chocolate covered raisins)
- Eggs & Cheddar Protein Box
- Prosnax Gala/Green Apples, Egg, White Cheddar Cheese, and Almonds/Cashews Snack Box (the lowest sodium option out of the boxes)
- Butter gourmet popcorn
- That’s It Apple + Blueberry Bar
- Blueberry & Oatmeal Jammy Sammy
Subway is the largest sandwich chain in the United States. You would think Subway out of all the other fast food options would be healthier, but honestly there are not very many kidney friendly choices. Most of their 6″ sandwiches contain more than 1000 mg sodium. According to their list of ingredients, all of their meat/protein options contain phosphate additives except for the tuna salad and the meatballs – however the meatballs are smothered in marinara sauce and high in sodium and potassium making it not a great choice for dialysis patients. Avoid all wraps and breakfast items as they are loaded in sodium. Hold the banana and jalapeño peppers, pickles, black olives, and tomatoes in the below options and avoid adding chips to help decrease sodium/potassium content.
Your Best Bets:
- Tuna salad sandwich, protein bowl, or salad
- Veggie Delight Sandwich with Swiss cheese
- Oven roasted chicken sandwich or salad
- Turkey breast sandwich or salad
- Sweet onion chicken teriyaki sandwich or salad
- Fresh brewed iced tea
- Dasani water
With almost 40,000 restaurants world-wide, McDonald’s is by far the most popular fast food option. Unfortunately, there are so many poor choices for dialysis patients. All the breakfast sausage is injected with salt and sugar, the biscuits and pancakes with salt and phosphate additives, the hamburger patties with salt, the pickles with salt and potassium sorbate (a preservative), the ketchup with high fructose corn syrup, and salt, the hotcake syrup with high fructose corn syrup, sugar, and potassium sorbate, the processed cheese, the list goes on. Below are a few tips to help make your meal a better choice:
- Ask for no cheese or pickles and no ketchup and mustard (or on the side so you can control the amount).
- Most of the breakfast menu is very high in sodium and phosphorus. Avoid the hotcakes, McGriddles, hash browns, most breakfast sandwiches (especially with biscuits), sausage burrito.
- Ditch the french fries (high in potassium and sodium).
- Most of the desserts, shakes, smoothies, McCafe drinks are not good choices.
Your Best Bets:
- Breakfast: Fruit & Maple Oatmeal, Egg McMuffin without the Canadian bacon.
- Coffee, Tea, Americano, Espresso (small=12 oz).
- Filet-O-Fish. Ask for tartar sauce on the side (contains salt and potassium sorbate).
- McChicken (contains phosphate additives, but is decent on sodium).
- Garden Salad
- McNuggets with Ranch or honey mustard. Reminder: this contains over 500mg sodium, so if eaten with a sandwich that would easily put your meal over 1000 mg sodium. Only choose if you don’t plan on having a sandwich/burger.
- Sides: apple slices, pineapple stick
- Dessert: apple pie
- Drinks (small=16 oz/2 cups): iced tea, water, Sprite, or apple juice (12 oz). Add a lot of ice and enjoy slowly.
Kentucky Fried Chicken is the 4th largest fast food restaurant chain. I really tried to come up with some best bets, but I feel it is one of the worst fast food options you could choose from. The chicken is poor quality and loaded with salt, MSG, and phosphate additives. Eating only one grilled chicken drumstick would give you over 1100 mg sodium and that’s not including sides like high phosphorus/sodium biscuits, mac and cheese, mashed potatoes and gravy, and BBQ baked beans. I would advise to stay clear of most things on their menu except the following sides: green beans, sweet corn, corn on cob, coleslaw, macaroni salad, side salad, apple turnover. Not a lot of recommended choices, sorry!
A poor version of Mexican food if you ask me. While not the most popular fast food chain out there, I figured I would throw it in for some variety. Most menu items are very high in potassium, sodium, and phosphorus not leaving a whole lot of kidney friendly choices. Their seasoned beef contains phosphate additives and just one regular bean burrito contains 1000 mg of sodium! Without red sauce and cheddar cheese it’s still 800 mg of sodium. Their cheese sauce contains phosphate and potassium additives. Most of the breakfast menu, all burritos and quesadillas, power menu bowls, quesalupas, crunchwraps, and nachos are no bueno. The following are your Best Bets:
- 1-2 Crunchy Tacos without cheese or tomatoes or added hot sauce. Perfect time to use your own salt free hot sauce!
- 1 Soft Taco without cheese, tomatoes, hot sauce. Option to add rice. Note: the flour tortilla has phosphorus additives.
- Chalupa or Black Bean Chalupa with lettuce, onions, and sour cream
- Chicken Chipotle Melt
- A side of chips and nacho cheese sauce. Not the healthiest choice and the cheese sauce contains phosphate additives, but it contains an acceptable amount of sodium per portion.
- Sweets: Cinnabon delights, cinnamon twists.
- Drinks (small=16 oz/2 cups): coffee, regular iced coffee, water. Note: most fountain beverages contain over 50g of sugar and Brisk iced tea – even though it comes unsweetened – contains phosphoric acid (a phosphorus additive).
Eating Out On A Renal Diet: Recap
Whew! I feel like we covered a lot of different eating out options. From Asian to Taco Bell you should be set to make the best dialysis friendly choices. While it is best and much healthier to prepare meals at home, there will always be occasions where you are going to eat out. Just remember the Tips & Tricks and definitely have your phosphorus binders on you!
Wishing you happy, healthy eating with no regrets!
Check out a downloadable version including a grocery list, two day sample meal plan, and a goals section HERE.